| NPI | 1417424995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHA FENTON Credentialing Specialist 714-841-6885 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2018-11-01 |