Provider Demographics
NPI:1679260244
Name:LAC COUNSELING, LICENSED CLINICAL SOCIAL WORKER INC
Entity type:Organization
Organization Name:LAC COUNSELING, LICENSED CLINICAL SOCIAL WORKER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:DINKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:858-789-0623
Mailing Address - Street 1:2605 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-3048
Mailing Address - Country:US
Mailing Address - Phone:858-789-0623
Mailing Address - Fax:
Practice Address - Street 1:2605 MADISON AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-3048
Practice Address - Country:US
Practice Address - Phone:858-789-0623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)