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General NPI Number Information
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NPI Number | 1407424609
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Entity Type | Organization
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Legal Business Name | PRIMAVERA COUNSELING LICENSED CLINICAL SOCIAL WORKER CORPORATION
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 11110 LOS ALAMITOS BLVD
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3602
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Country | US
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Telephone | 562-380-1376
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Fax |
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Provider Business Mailing Address
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Address Line | 6475 E PACIFIC COAST HWY # 418
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City | LONG BEACH
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State | CA
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Zip | 90803-4201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARIA VIRGEN ELIAS
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Credential | LCSW
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Telephone | 562-380-1376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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