Provider Demographics
NPI:1821600529
Name:PRINCE, DAVID JAMES (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:PRINCE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 15TH ST APT 1810
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7776
Mailing Address - Country:US
Mailing Address - Phone:214-606-0917
Mailing Address - Fax:
Practice Address - Street 1:1498 13TH STREET BLDG 184
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:98132
Practice Address - Country:US
Practice Address - Phone:214-606-0917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX634231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical