Healthcare Provider Details

I. General information

NPI: 1386559722
Provider Name (Legal Business Name): LD INDIVIDUAL AND FAMILY COUNSELING PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16541 GOTHARD ST STE 202
HUNTINGTON BEACH CA
92647-4473
US

IV. Provider business mailing address

16541 GOTHARD ST STE 202
HUNTINGTON BEACH CA
92647-4473
US

V. Phone/Fax

Practice location:
  • Phone: 760-840-0764
  • Fax:
Mailing address:
  • Phone: 760-840-0764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: LAURIE DAVIS
Title or Position: LMFT
Credential: LMFT
Phone: 760-840-0764