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General NPI Number Information
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NPI Number | 1770887499
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Entity Type | Organization
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Legal Business Name | FROM CHRYSALIS TO WINGS PSYCHOTHERAPY AND RESEARCH CENTER
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 27285 LAS RAMBLAS SUITE 232
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6325
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Country | US
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Telephone | 949-633-3995
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Fax | 949-916-6852
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Provider Business Mailing Address
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Address Line | 30021 TOMAS STE 300
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-2128
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Country | US
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Telephone | 949-916-6851
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Fax | 949-916-6852
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. FRANCINE CARRIER-ZOREHKEY
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Credential | PH.D., L.M.F.T.
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Telephone | 949-916-6852
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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 | MFT47234
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License Number State | CA
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