Basic Information
| Provider Information | |||||||||
| NPI: | 1326664731 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIACOMINI | ||||||||
| FirstName: | ANDRESSA | ||||||||
| MiddleName: | GOMES | ||||||||
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| Credential: | AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6219 STANLEY AVE APT 7 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921154048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814265146 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3230 WARING CT STE A | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920564509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603057528 | ||||||||
| FaxNumber: | 7605094410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2020 | ||||||||
| LastUpdateDate: | 01/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | AMFT117080 | CA | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | AMFT117080 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.