Healthcare Provider Details

I. General information

NPI: 1942508320
Provider Name (Legal Business Name): SOUTH BAY CENTER FOR COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 N MARINE AVE
WILMINGTON CA
90744-5528
US

IV. Provider business mailing address

540 N MARINE AVE
WILMINGTON CA
90744-5528
US

V. Phone/Fax

Practice location:
  • Phone: 310-414-2090
  • Fax: 310-414-2096
Mailing address:
  • Phone: 310-414-2090
  • Fax: 310-414-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: SELENE KETCHUM
Title or Position: DIRECTOR COMMUNITY-BASED DOULA SUPP
Credential:
Phone: 310-491-4948