Provider Demographics
NPI:1538306931
Name:INSTITUTE ON VIOLENCE, ABUSE, & TRAUMA @ ALLIANT INTERNATIONAL UNIVERS
Entity Type:Organization
Organization Name:INSTITUTE ON VIOLENCE, ABUSE, & TRAUMA @ ALLIANT INTERNATIONAL UNIVERS
Other - Org Name:FAMILY VIOLENCE AND SEXUAL ASSUALT INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GEFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-527-1860
Mailing Address - Street 1:10065 OLD GROVE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1664
Mailing Address - Country:US
Mailing Address - Phone:858-527-1860
Mailing Address - Fax:858-527-1743
Practice Address - Street 1:10065 OLD GROVE RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1664
Practice Address - Country:US
Practice Address - Phone:858-527-1860
Practice Address - Fax:858-527-1743
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIANT INTERNATIONAL UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16109251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health