Provider Demographics
NPI:1932635604
Name:DEGROFF, MAEGEN (LPCC 11673)
Entity Type:Individual
Prefix:
First Name:MAEGEN
Middle Name:
Last Name:DEGROFF
Suffix:
Gender:F
Credentials:LPCC 11673
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8885 RIO SAN DIEGO DR STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1610
Mailing Address - Country:US
Mailing Address - Phone:619-345-4611
Mailing Address - Fax:
Practice Address - Street 1:8885 RIO SAN DIEGO DR STE 301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1610
Practice Address - Country:US
Practice Address - Phone:619-345-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA390200000X
CA11673101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program