Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY 17166 | CA |
N | 103T00000X | Psychologist | PSY 17166 | CA |
Y | 103G00000X | Clinical Psychologist | PSY 17166 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 17166 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY 17166 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PSY 17166 | CA |
NPI | 1326099318 |
---|---|
Provider Name | Dr. Christauria Gillian Welland-Akong |
First Address | San Diego, CA 92129-4316 |
Second Address | Solana Beach, CA 92075-2408 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 02/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17166 | (05) | CA |