Provider Demographics
NPI:1174540157
Name:CANTERBURY, LOUIS THEODORE II (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:THEODORE
Last Name:CANTERBURY
Suffix:II
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:VA SAN DIEGO
Mailing Address - Street 2:3350 LA JOLLA VILLAGE DR, SPID S 118
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92161-0001
Mailing Address - Country:US
Mailing Address - Phone:858-642-3186
Mailing Address - Fax:858-552-4311
Practice Address - Street 1:VA SAN DIEGO
Practice Address - Street 2:3350 LA JOLLA VILLAGE DR, SPID S 118
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0001
Practice Address - Country:US
Practice Address - Phone:858-642-3186
Practice Address - Fax:858-552-4311
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 236121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical