Provider Demographics
NPI:1972632479
Name:HHSA
Entity Type:Organization
Organization Name:HHSA
Other - Org Name:COUNTY MENTAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CONCELLOSI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:619-758-6205
Mailing Address - Street 1:1715 31ST ST
Mailing Address - Street 2:3320 KEMPER ST. SUITE#104
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-1425
Mailing Address - Country:US
Mailing Address - Phone:619-758-6205
Mailing Address - Fax:619-758-6209
Practice Address - Street 1:1715 31ST ST
Practice Address - Street 2:3320 KEMPER ST. SUITE3104
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-1425
Practice Address - Country:US
Practice Address - Phone:619-758-6205
Practice Address - Fax:619-758-6209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS13561101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty