Organization
AVIVA PSYCHOLOGICAL SERVICES, APC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAINA R PONCE PHD (OWNER/CEO)
(619) 786-5866
Entity
Organization
Contact information
Practice address
2831 CAMINO DEL RIO S STE 308, SAN DIEGO, CA 92108-3829
(619) 786-5866
Mailing address
117 COOLWATER DR, SAN DIEGO, CA 92114-7308
(707) 328-7400
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
—
—
103TC0700X
Clinical Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Enumeration date
02/12/2024
Last updated
03/24/2026
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