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SAN DIEGO STATE UNIVERSITY - HEALTHY EARLY YEARS CLINIC
NPI 1124849658
Counselor in San Diego, CA

Active since October 17, 2024
4283 EL CAJON BLVD, SUITE 200, SAN DIEGO, CA 92105(619) 530-0122(619) 530-0822 Get Directions Write a Review

NPPES record last updated: October 17, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About San Diego State University - Healthy Early Years Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAN DIEGO STATE UNIVERSITY - HEALTHY EARLY YEARS CLINIC (NPI 1124849658) is a healthcare organization registered as a counselor in San Diego, California and active in the NPI registry since October 2024. The organization lists Agnes Wong Nickerson, Associate Vp Of Financial Operation, as its authorized official.

NPPES Registry Identity

NPI1124849658
Entity TypeOrganization
Primary Taxonomy101Y00000X
Legal Business NameSAN DIEGO STATE UNIVERSITY - HEALTHY EARLY YEARS CLINIC
Location Address4283 EL CAJON BLVD, SUITE 200San Diego, CA 92105
Mailing Address5500 Campanile DrSan Diego, CA 92182-1518 · (619) 594-6017 · Fax (619) 594-5917
Phone(619) 530-0122
Fax(619) 530-0822
Organization SubpartYesParent: San Diego State University
Authorized OfficialAgnes Wong NickersonAssociate Vp Of Financial Operation · (619) 594-6017
Enumeration DateOctober 17, 2024
✔ NPI 1124849658 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers
Taxonomy Code101Y00000X
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
Also ListedSocial WorkerTaxonomy 104100000X
Also ListedMarriage & Family TherapistTaxonomy 106H00000X
4283 EL CAJON BLVD, San Diego, CA 92105
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NANCY HOGUE
Marriage & Family Therapist
4283 EL CAJON BLVD
SAN DIEGO, CA 92105
San Diego County (619) 521-1743
SUZANNE YOUNG TAYLOR PCI, MA
Counselor
4283 EL CAJON BLVD, SUITE 115
SAN DIEGO, CA 92105
San Diego County (619) 521-1743
CHRISTINE MARIE GARCIA
Case Manager/Care Coordinator
4283 EL CAJON BLVD, STE. 115
SAN DIEGO, CA 92105
San Diego County (619) 521-1743
MR. JOSHUA CHARLES PELFREY MSW
Social Worker
4283 EL CAJON BLVD
SAN DIEGO, CA 92105
San Diego County (619) 219-1580
CECILIA RENEE VILLEGAS
Social Worker (Clinical)
4283 EL CAJON BLVD
SAN DIEGO, CA 92105
San Diego County (619) 521-1743
NISA GENCEL
Counselor (Mental Health)
4283 EL CAJON BLVD, SUITE 200
SAN DIEGO, CA 92105
San Diego County (619) 371-5420
ADRIANNA RAMIREZ
Specialist
4283 EL CAJON BLVD, SUITE 115
SAN DIEGO, CA 92105
San Diego County (619) 521-1743
MS. LUCINDA J MOANEY MC/MFCT
Marriage & Family Therapist
4283 EL CAJON BLVD, STE. 115
SAN DIEGO, CA 92105
San Diego County (619) 521-1743

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is San Diego State University - Healthy Early Years Clinic's NPI number?

The NPI number for San Diego State University - Healthy Early Years Clinic is 1124849658. It was assigned to this organization in the NPPES registry on October 17, 2024.

Where is San Diego State University - Healthy Early Years Clinic located?

San Diego State University - Healthy Early Years Clinic is located at 4283 El Cajon Blvd Suite 200, San Diego, CA 92105. The listed phone number is (619) 530-0122.

What is San Diego State University - Healthy Early Years Clinic's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

When was this NPI record last updated?

The NPPES record for San Diego State University - Healthy Early Years Clinic was last updated on October 17, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.