Provider Demographics
NPI:1629172663
Name:PIERCE, CAROL LEE (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LEE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 OLD TOWN AVE
Mailing Address - Street 2:SUITE A207
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2930
Mailing Address - Country:US
Mailing Address - Phone:619-299-1043
Mailing Address - Fax:619-283-3443
Practice Address - Street 1:3990 OLD TOWN AVE
Practice Address - Street 2:SUITE A207
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2930
Practice Address - Country:US
Practice Address - Phone:619-299-1043
Practice Address - Fax:619-283-3443
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT14864106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist