Provider Demographics
NPI:1619044492
Name:NORTH COASTAL SAN DIEGO LICENSED CLINICAL SOCIAL WORKERS, INC.
Entity Type:Organization
Organization Name:NORTH COASTAL SAN DIEGO LICENSED CLINICAL SOCIAL WORKERS, INC.
Other - Org Name:NORTH COAST COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER OF CORPORATION
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANSCHAGRIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LICSW
Authorized Official - Phone:760-436-1883
Mailing Address - Street 1:826 SECOND ST
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4408
Mailing Address - Country:US
Mailing Address - Phone:760-436-1883
Mailing Address - Fax:760-436-9862
Practice Address - Street 1:826 SECOND ST
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4408
Practice Address - Country:US
Practice Address - Phone:760-436-1883
Practice Address - Fax:760-436-9862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS11666104100000X
CALCS11440104100000X
CALCS23035104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18105Medicare ID - Type Unspecified