| NPI | 1740653963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE MARIE VIENNA Vice President & Clinical Director 949-290-3947 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 26945) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 103TF0000X Psychologist, Family (Licence: CA 26945) | |
| 103TF0200X Psychologist, Forensic (Licence: CA 26945) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA 26945) | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2015-11-10 |
| Last Update Date | 2017-02-28 |