Healthcare Provider Details

I. General information

NPI: 1679085336
Provider Name (Legal Business Name): SOCIAL COLLABORATIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 EL CAMINO REAL STE 200
TUSTIN CA
92780-3605
US

IV. Provider business mailing address

2441 E 3RD ST
LONG BEACH CA
90814-2205
US

V. Phone/Fax

Practice location:
  • Phone: 415-646-6223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HSING AN DAISY WANG
Title or Position: OWNER
Credential: BCBA
Phone: 415-646-6223