Basic Information
| Provider Information | |||||||||
| NPI: | 1891965760 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WINSTON-RUSSELL | ||||||||
| FirstName: | GIANA | ||||||||
| MiddleName: | LYNNE | ||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | WINSTON | ||||||||
| OtherFirstName: | GIANA | ||||||||
| OtherMiddleName: | LYNNE | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6673 CHARLENE AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921141616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197504040 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4660 EL CAJON BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921154450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195977335 | ||||||||
| FaxNumber: | 6196422735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2008 | ||||||||
| LastUpdateDate: | 01/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.