Healthcare Provider Details

I. General information

NPI: 1295962850
Provider Name (Legal Business Name): ASSOCIATES IN COUNSELING & MEDIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 S. ANITA AVE SUITE 117
ORANGE CA
92868-3341
US

IV. Provider business mailing address

265 SOUTH ANITA AVE SUITE 117
ORANGE CA
92868-3341
US

V. Phone/Fax

Practice location:
  • Phone: 714-978-1090
  • Fax: 714-978-1087
Mailing address:
  • Phone: 714-978-1090
  • Fax: 714-978-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA 4002607
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 15648
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 33649
License Number StateCA

VIII. Authorized Official

Name: MRS. MARIANNE ABULONE
Title or Position: OWNER/CLINICIAN/SUPERVISOR
Credential: MFC 33649
Phone: 714-978-1090