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General NPI Number Information
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NPI Number | 1184320095
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Entity Type | Organization
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Legal Business Name | MIRANDA COUNSELING & CONSULTING LICENSED CLINICAL SOCIAL WORKER, INC.
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Dates
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Enumeration Date | 02/02/2023
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 2204 S EL CAMINO REAL STE 305
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City | OCEANSIDE
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State | CA
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Zip | 92054-6376
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Country | US
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Telephone | 760-509-2360
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8685
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City | ANAHEIM
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State | CA
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Zip | 92812-0685
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Country | US
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Telephone | 760-509-2360
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER/CEO
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Name | MAYOLA MIRANDA
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Credential | LCSW
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Telephone | 760-509-2360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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