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General NPI Number Information
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NPI Number | 1164786851
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Entity Type | Organization
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Legal Business Name | SAGE COUNSELING SERVICES, INC
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 18411 CRENSHAW BLVD SUITE 413
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City | TORRANCE
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State | CA
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Zip | 90504-5042
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Country | US
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Telephone | 310-358-4421
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Fax | 323-843-9371
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Provider Business Mailing Address
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Address Line | 18411 CRENSHAW BLVD SUITE 413
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City | TORRANCE
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State | CA
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Zip | 90504-5042
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Country | US
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Telephone | 310-358-4421
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Fax | 323-843-9371
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MRS. ANA CARLA GOMES LAIDLEY
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Credential | LMFT
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Telephone | 310-538-4421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC44112
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License Number State | CA
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