Provider Demographics
NPI:1912436205
Name:TICA, TAYLOR MARIE (MA, LPCC)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:MARIE
Last Name:TICA
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8880 RIO SAN DIEGO DR STE 800
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1642
Mailing Address - Country:US
Mailing Address - Phone:760-557-5572
Mailing Address - Fax:
Practice Address - Street 1:8880 RIO SAN DIEGO DR STE 800
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1642
Practice Address - Country:US
Practice Address - Phone:760-557-5572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health