Provider Demographics
NPI:1730336520
Name:NORTH COUNTY LIFELINE
Entity type:Organization
Organization Name:NORTH COUNTY LIFELINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BEHAVIORAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:760-757-0118
Mailing Address - Street 1:200 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-5424
Mailing Address - Country:US
Mailing Address - Phone:760-726-4900
Mailing Address - Fax:760-631-0118
Practice Address - Street 1:200 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5424
Practice Address - Country:US
Practice Address - Phone:760-726-4900
Practice Address - Fax:760-631-0778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH COUNTY LIFELINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37FXOtherDMH