Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY 5502 | CA |
Y | 103G00000X | Clinical Psychologist | PSY 5502 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 5502 | CA |
NPI | 1497925093 |
---|---|
Provider Name | Dr. J Roland Fleck |
First Address | Encinitas, CA 92024-4940 |
Second Address | Encinitas, CA 92024-4940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2008 |
Last Update Date | 10/03/2008 |