Healthcare Provider Details

I. General information

NPI: 1306916168
Provider Name (Legal Business Name): DIVERSIFIED COUNSELING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13672 GOLDENWEST ST SUITE I
WESTMINSTER CA
92683-7911
US

IV. Provider business mailing address

23177 LA CADENA DR SUITE 103
LAGUNA HILLS CA
92653-1428
US

V. Phone/Fax

Practice location:
  • Phone: 714-895-0933
  • Fax: 714-895-1430
Mailing address:
  • Phone: 949-455-0744
  • Fax: 949-455-9822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. MARTHA BERMUDEZ EDGLEY
Title or Position: ASSOCIATE DIRECTOR
Credential:
Phone: 714-667-1196