Provider Demographics
NPI:1841779154
Name:CARLA PAYNE, PSYCHOLOGY, INC.
Entity Type:Organization
Organization Name:CARLA PAYNE, PSYCHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPT
Authorized Official - Prefix:MR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:LINDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-652-0308
Mailing Address - Street 1:P.O. BOX 7107 BROADWAY PMB 335
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945
Mailing Address - Country:US
Mailing Address - Phone:858-922-3803
Mailing Address - Fax:951-658-5857
Practice Address - Street 1:2525 CAMINO DEL RIO S. #245
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:858-922-3803
Practice Address - Fax:951-658-5857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24538103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty