Provider Demographics
NPI:1477755486
Name:LAHUE, ATHENA B (CAS II)
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:B
Last Name:LAHUE
Suffix:
Gender:F
Credentials:CAS II
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:B
Other - Last Name:LAHUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CAS II
Mailing Address - Street 1:523 SHADOW HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-3239
Mailing Address - Country:US
Mailing Address - Phone:760-294-6698
Mailing Address - Fax:
Practice Address - Street 1:2821 OCEANSIDE BLVD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4800
Practice Address - Country:US
Practice Address - Phone:760-721-2781
Practice Address - Fax:760-721-9571
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01 027813101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)