Provider Demographics
NPI:1679007181
Name:SD INTERVIEW
Entity Type:Organization
Organization Name:SD INTERVIEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANCOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-964-8288
Mailing Address - Street 1:8885 RIO SAN DIEGO DR STE 365
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1627
Mailing Address - Country:US
Mailing Address - Phone:619-964-8288
Mailing Address - Fax:619-566-4126
Practice Address - Street 1:8885 RIO SAN DIEGO DR STE 365
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1627
Practice Address - Country:US
Practice Address - Phone:619-964-8288
Practice Address - Fax:619-566-4126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT53346106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty