Healthcare Provider Details

I. General information

NPI: 1528576261
Provider Name (Legal Business Name): RHODEL CHRISTINE KABAH MA, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RHODEL CHRISTINE SWANIKER

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date: 11/13/2020
Reactivation Date: 03/01/2023

III. Provider practice location address

3600 LIME ST # 216-103A
RIVERSIDE CA
92501-2971
US

IV. Provider business mailing address

1968 S COAST HWY # 803
LAGUNA BEACH CA
92651-3681
US

V. Phone/Fax

Practice location:
  • Phone: 877-712-5220
  • Fax: 844-300-5483
Mailing address:
  • Phone: 210-390-6929
  • Fax: 844-300-5483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number19942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: