Provider Demographics
NPI:1609006436
Name:DREYER, TAMELA S (LCSW)
Entity type:Individual
Prefix:
First Name:TAMELA
Middle Name:S
Last Name:DREYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3639 MIDWAY DR
Mailing Address - Street 2:B135
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5254
Mailing Address - Country:US
Mailing Address - Phone:619-368-2122
Mailing Address - Fax:
Practice Address - Street 1:8950 VILLA LA JOLLA DR
Practice Address - Street 2:A220
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1714
Practice Address - Country:US
Practice Address - Phone:619-368-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical