Healthcare Provider Details

I. General information

NPI: 1093489569
Provider Name (Legal Business Name): DAVID JOSHUA SERBIN M.A., AMFT, APCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 CAMINO MIRA COSTA STE T
SAN CLEMENTE CA
92672-3508
US

IV. Provider business mailing address

26741 PORTOLA PKWY STE 1E
FOOTHILL RANCH CA
92610-1763
US

V. Phone/Fax

Practice location:
  • Phone: 949-272-4444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number120693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: