Active NPI
Octavia Mack
- Mental Health Counselor
- San Diego, CA
National Provider Identifier
1649034810
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 1925 Euclid Ave
San Diego, CA 92105-5361 - Phone
- (619) 648-1158
- NPI assigned
- Feb 8, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
1925 Euclid Ave
San Diego, CA 92105-5361
Mailing address
1925 Euclid Ave
San Diego, CA 92105-5361
Phone (619) 648-1158
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Urban Restoration Counseling Center | Mental Health | Current | Accepting new patients |
Locations
1925 Euclid Ave
San Diego, CA 92105
Phone (619) 648-1153
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707350400000",
"number": "1649034810",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1925 EUCLID AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921055361",
"telephone_number": "619-648-1158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1925 EUCLID AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921055361",
"telephone_number": "619-648-1158"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "OCTAVIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-08",
"last_updated": "2024-02-08",
"certification_date": "2024-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.