Provider Demographics
NPI:1144277955
Name:HUGGINS, JANICE LAVONNE (MFT)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:LAVONNE
Last Name:HUGGINS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:LAVONNE
Other - Last Name:LYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 609001
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-9001
Mailing Address - Country:US
Mailing Address - Phone:619-528-4600
Mailing Address - Fax:619-528-4625
Practice Address - Street 1:1550 HOTEL CIR N STE 270
Practice Address - Street 2:STE# 270
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2908
Practice Address - Country:US
Practice Address - Phone:619-688-5855
Practice Address - Fax:619-291-3310
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41830106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW416Medicare PIN