Provider Demographics
NPI:1174286223
Name:FONDREN, MEGAN KRISTINA (LCSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:KRISTINA
Last Name:FONDREN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5064 VIA MANOS UNIT B
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-4530
Mailing Address - Country:US
Mailing Address - Phone:404-317-1573
Mailing Address - Fax:
Practice Address - Street 1:1300 RANCHO DEL ORO RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-1729
Practice Address - Country:US
Practice Address - Phone:404-317-1573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2025-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
CALCSW1276551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health