Provider Demographics
NPI:1164265435
Name:DRIFTWOOD FAMILY THERAPY COLLECTIVE, CORP.
Entity type:Organization
Organization Name:DRIFTWOOD FAMILY THERAPY COLLECTIVE, CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NYZNYK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-874-2872
Mailing Address - Street 1:1038 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3915
Mailing Address - Country:US
Mailing Address - Phone:310-874-2872
Mailing Address - Fax:
Practice Address - Street 1:2121 NEWCASTLE AVE STE D
Practice Address - Street 2:
Practice Address - City:CARDIFF
Practice Address - State:CA
Practice Address - Zip Code:92007-1861
Practice Address - Country:US
Practice Address - Phone:310-874-2872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty