| NPI | 1770314270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA MARIE WAGNER Provider 949-447-8257 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 103T00000X Psychologist |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2024-08-08 |
| Last Update Date | 2024-11-06 |