Provider Demographics
NPI:1437654449
Name:LIVE INSPIRED CHILD & FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:LIVE INSPIRED CHILD & FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISABELLE
Authorized Official - Middle Name:DOMINIQUE
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-784-3883
Mailing Address - Street 1:5811 AMAYA DR STE 204
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-4156
Mailing Address - Country:US
Mailing Address - Phone:619-933-4105
Mailing Address - Fax:
Practice Address - Street 1:5811 AMAYA DR STE 204
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-4156
Practice Address - Country:US
Practice Address - Phone:619-784-3884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105070106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty