Individual
DEBORAH BUKOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2772 4TH AVE, SAN DIEGO, CA 92103-6206
(619) 295-6067
Mailing address
355 C AVE, CORONADO, CA 92118-1405
(619) 319-7789
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
06/03/2010
Last updated
06/07/2011
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