Basic Information
| Provider Information | |||||||||
| NPI: | 1023433059 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE-LAUDUSKI | ||||||||
| FirstName: | ALICIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1202 MORENA BLVD | ||||||||
| Address2: | 203 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921103841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6193983261 | ||||||||
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| Practice Location | |||||||||
| Address1: | 474 W VERMONT AVE | ||||||||
| Address2: | 103 | ||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920256584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607450281 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2014 | ||||||||
| LastUpdateDate: | 07/14/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF77823 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.