Provider Demographics
NPI:1922553403
Name:GARAY, JOANNA (APCC)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:GARAY
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3132 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4421
Mailing Address - Country:US
Mailing Address - Phone:619-683-3100
Mailing Address - Fax:
Practice Address - Street 1:105 N ROSE ST STE 211
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-3109
Practice Address - Country:US
Practice Address - Phone:760-855-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9505101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health