Organization
CHRISTIAN COUNSELING OF COLUMBIA PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN VENN PH.D. (PRESIDENT)
(619) 692-3736
Entity
Organization
Contact information
Practice address
8555 STATION VILLAGE LN, #3139, SAN DIEGO, CA 92108-6543
(619) 692-3736
Mailing address
8555 STATION VILLAGE LN, #3139, SAN DIEGO, CA 92108-6543
(619) 692-3736
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PSY 22538
CA
103TC0700X
Clinical Psychologist
Primary
PSY 22538
CA
103TF0200X
Forensic Psychologist
PSY 22538
CA
Other
Enumeration date
04/15/2009
Last updated
04/15/2009
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