Provider Demographics
NPI:1932234630
Name:NEMBHARD, ADIA A (MFC53593)
Entity Type:Individual
Prefix:
First Name:ADIA
Middle Name:A
Last Name:NEMBHARD
Suffix:
Gender:F
Credentials:MFC53593
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 CAMINO DEL RIO S STE 215
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3837
Mailing Address - Country:US
Mailing Address - Phone:951-809-7046
Mailing Address - Fax:619-610-9287
Practice Address - Street 1:3333 CAMINO DEL RIO S STE 215
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3837
Practice Address - Country:US
Practice Address - Phone:951-809-7046
Practice Address - Fax:619-610-9287
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53593106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist