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General NPI Number Information
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NPI Number | 1588960322
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Entity Type | Organization
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Legal Business Name | CENTER OF COMPASSIONATE CARE
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Dates
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Enumeration Date | 01/26/2011
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Last Update Date | 06/14/2011
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Provider Practice Location Address
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Address Line | 2030 E 4TH ST SUITE 140F
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City | SANTA ANA
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State | CA
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Zip | 92705-3940
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Country | US
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Telephone | 714-569-9976
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Fax | 714-569-9910
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Provider Business Mailing Address
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Address Line | 2030 E 4TH ST SUITE 140F
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City | SANTA ANA
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State | CA
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Zip | 92705-3940
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Country | US
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Telephone | 714-569-9976
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Fax | 714-569-9910
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Authorized Official
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Title or Position | OWNER
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Name | DR. AGNES CLAIRE DICKSON
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Credential |
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Telephone | 714-569-9910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY12015
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License Number State | CA
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