Provider Demographics
NPI:1629201132
Name:PSYCHOLOGY CENTER, INC.
Entity Type:Organization
Organization Name:PSYCHOLOGY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:MOLNAR
Authorized Official - Last Name:WARCHOLA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:650-384-9164
Mailing Address - Street 1:836 PROSPECT ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4213
Mailing Address - Country:US
Mailing Address - Phone:650-384-9164
Mailing Address - Fax:
Practice Address - Street 1:836 PROSPECT ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4213
Practice Address - Country:US
Practice Address - Phone:650-384-9164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22211103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty