Provider Demographics
NPI:1518240530
Name:ROBERTS, GENIVA A (LMFT, PCCI, CADC-II)
Entity Type:Individual
Prefix:
First Name:GENIVA
Middle Name:A
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LMFT, PCCI, CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 S TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-5309
Mailing Address - Country:US
Mailing Address - Phone:760-439-2800
Mailing Address - Fax:
Practice Address - Street 1:1202 MORENA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3841
Practice Address - Country:US
Practice Address - Phone:619-275-0822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2017-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83766106H00000X
CA100491106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist