Healthcare Provider Details

I. General information

NPI: 1336232149
Provider Name (Legal Business Name): K. C. SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 E SAN ALANO AVE
ORANGE CA
92865-1520
US

IV. Provider business mailing address

1520 E SAN ALANO AVE
ORANGE CA
92865-1520
US

V. Phone/Fax

Practice location:
  • Phone: 714-222-9972
  • Fax:
Mailing address:
  • Phone: 714-222-9972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number30-006-02-100
License Number StateCA

VIII. Authorized Official

Name: MS. CAROLINA ECHEVERRIA GONZALEZ
Title or Position: DUI PROGRAM COORDINATOR
Credential:
Phone: 714-638-5008