Provider Demographics
NPI:1821577081
Name:WEISENBURGER, ELIZABETH KATHERINE (MS, MA, CRC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:KATHERINE
Last Name:WEISENBURGER
Suffix:
Gender:F
Credentials:MS, MA, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 W LEWIS ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1755
Mailing Address - Country:US
Mailing Address - Phone:805-403-4289
Mailing Address - Fax:
Practice Address - Street 1:2103 S EL CAMINO REAL STE 206
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6281
Practice Address - Country:US
Practice Address - Phone:442-500-8548
Practice Address - Fax:760-400-8379
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC7817101Y00000X, 101YM0800X
171M00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program