Healthcare Provider Details

I. General information

NPI: 1992652291
Provider Name (Legal Business Name): ETERNAL OPTIMIST LICENSED CLINICAL SOCIAL WORKER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 S HORNE ST
OCEANSIDE CA
92054-4250
US

IV. Provider business mailing address

521 S HORNE ST
OCEANSIDE CA
92054-4250
US

V. Phone/Fax

Practice location:
  • Phone: 714-501-7563
  • Fax:
Mailing address:
  • Phone: 714-501-7563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ERICA MCDANIEL
Title or Position: CEO
Credential: LCSW
Phone: 714-501-7563