Provider Demographics
NPI:1780179960
Name:SHEPOSH, WILLIAM ANDREW (MA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ANDREW
Last Name:SHEPOSH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5275 CLAIREMONT MESA BOULEVARD
Mailing Address - Street 2:1
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117
Mailing Address - Country:US
Mailing Address - Phone:858-565-1942
Mailing Address - Fax:
Practice Address - Street 1:726 F STREET
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-6303
Practice Address - Country:US
Practice Address - Phone:619-239-9691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI2600315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)