| NPI | 1952084451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA MARIE WAGNER Clinical Director 949-781-9025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Additional Taxonomies | 2080P0008X Pediatrics Neurodevelopmental Disabilities |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2023-08-10 |
| Last Update Date | 2025-09-02 |