Healthcare Provider Details

I. General information

NPI: 1306373659
Provider Name (Legal Business Name): CAROLYN LODER MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN NOBLE LMFT

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30950 RANCHO VIEJO RD STE 175
SAN JUAN CAPISTRANO CA
92675-1772
US

IV. Provider business mailing address

30950 RANCHO VIEJO RD STE 175
SAN JUAN CAPISTRANO CA
92675-1772
US

V. Phone/Fax

Practice location:
  • Phone: 714-628-2000
  • Fax:
Mailing address:
  • Phone: 949-212-6383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: