Provider Demographics
NPI:1922379049
Name:THE SAN DIEGO LGBT COMMUNITY CENTER
Entity type:Organization
Organization Name:THE SAN DIEGO LGBT COMMUNITY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIR. OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:619-692-2077
Mailing Address - Street 1:PO BOX 3357
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163
Mailing Address - Country:US
Mailing Address - Phone:619-692-2077
Mailing Address - Fax:619-260-3093
Practice Address - Street 1:3909 CENTRE STREET
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-692-2077
Practice Address - Fax:619-260-3093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16841251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health