OrganizationActive
San Diego State University - Healthy Early Years Clinic
NPI 1124849658 · Counselor · San Diego, CA
Provider details
- NPI number
- 1124849658
- Entity type
- Organization
- Primary specialty
- CounselorBehavioral Health & Social Service Providers
- Parent organization
- San Diego State University
- Organization subpart
- Yes
- Authorized official
- Agnes Wong Nickerson, Associate Vp of Financial Operation(619) 594-6017
Specialties & taxonomies
Behavioral Health & Social Service Providers
- Social Worker104100000X
Behavioral Health & Social Service Providers
- Marriage & Family Therapist106H00000X
Behavioral Health & Social Service Providers
Profile Score
Established profile(56/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
1 yr in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
4283 El Cajon Blvd
Suite 200
San Diego, CA 92105
Phone: (619) 530-0122
Fax: (619) 530-0822
Street-level locationGet directions
Mailing address
5500 Campanile Dr
San Diego, CA 92182-1518
Registry dates
- Enumerated
- 2024-10-17
- Last updated
- 2024-10-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.