Provider Demographics
NPI:1841501582
Name:AVINA, CHERYL L (MFT)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:L
Last Name:AVINA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 3RD AVE
Mailing Address - Street 2:SUITE 916
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-4110
Mailing Address - Country:US
Mailing Address - Phone:619-236-6386
Mailing Address - Fax:619-533-3459
Practice Address - Street 1:1200 3RD AVE
Practice Address - Street 2:SUITE 916
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-4110
Practice Address - Country:US
Practice Address - Phone:619-236-6386
Practice Address - Fax:619-533-3459
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48504106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist