Provider Demographics
NPI:1477909331
Name:SAN DIEGO PSYCHOTHERAPY AND WELLNESS CENTER INC.
Entity Type:Organization
Organization Name:SAN DIEGO PSYCHOTHERAPY AND WELLNESS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SURRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-997-3260
Mailing Address - Street 1:705 PIER VIEW WAY STE A
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-2848
Mailing Address - Country:US
Mailing Address - Phone:442-500-8200
Mailing Address - Fax:442-615-7422
Practice Address - Street 1:705 PIER VIEW WAY STE A
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-2848
Practice Address - Country:US
Practice Address - Phone:442-500-8200
Practice Address - Fax:442-615-7422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84629106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty