Healthcare Provider Details

I. General information

NPI: 1700461134
Provider Name (Legal Business Name): ALISA ARIELLE CARSTENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 CAMINO MIRA COSTA STE T
SAN CLEMENTE CA
92672-3508
US

IV. Provider business mailing address

525 CABRILLO PARK DR STE 300
SANTA ANA CA
92701-5017
US

V. Phone/Fax

Practice location:
  • Phone: 949-272-4444
  • Fax: 949-272-4445
Mailing address:
  • Phone: 714-953-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: