Provider Demographics
NPI:1912475757
Name:ENNIS, CECILIA G (LMFT)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:G
Last Name:ENNIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 882505
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92168-2505
Mailing Address - Country:US
Mailing Address - Phone:619-315-8807
Mailing Address - Fax:
Practice Address - Street 1:6330 ALVARADO CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4912
Practice Address - Country:US
Practice Address - Phone:619-315-8807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88020101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health