Healthcare Provider Details

I. General information

NPI: 1104826072
Provider Name (Legal Business Name): THE NEW BEGINNING FELLOWSHIP CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16581 BROOKHURST ST
FOUNTAIN VALLEY CA
92708-2344
US

IV. Provider business mailing address

16581 BROOKHURST ST
FOUNTAIN VALLEY CA
92708-2344
US

V. Phone/Fax

Practice location:
  • Phone: 714-839-2515
  • Fax: 714-839-5501
Mailing address:
  • Phone: 714-839-2515
  • Fax: 714-839-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number300120AN
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number300120BN
License Number StateCA

VIII. Authorized Official

Name: MR. ALONZO MITCHELL
Title or Position: CEO
Credential:
Phone: 714-839-2515