Provider Demographics
NPI:1295523264
Name:GWYNN, ALICIA
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:GWYNN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14374 OLD CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-4274
Mailing Address - Country:US
Mailing Address - Phone:619-977-9295
Mailing Address - Fax:
Practice Address - Street 1:14374 OLD CREEK RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-4274
Practice Address - Country:US
Practice Address - Phone:619-977-9295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral