Basic Information
Provider Information
NPI: 1164501698
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FINCH
FirstName: KARI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: ASW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: JOHNSON
OtherFirstName: KARI
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: MSW
OtherLastNameType: 1
Mailing Information
Address1: 1202 MORENA BLVD
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921103841
CountryCode: US
TelephoneNumber: 6193983261
FaxNumber:  
Practice Location
Address1: 1202 MORENA BLVD
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921103841
CountryCode: US
TelephoneNumber: 6193983261
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/03/2006
LastUpdateDate: 03/15/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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