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General NPI Number Information
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NPI Number | 1912326570
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Entity Type | Organization
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Legal Business Name | CRISTINA E. FREESE L.C.S.W.
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 04/10/2014
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Provider Practice Location Address
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Address Line | 18800 DELAWARE ST SUITE 308
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-1959
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Country | US
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Telephone | 714-917-9933
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Fax |
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Provider Business Mailing Address
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Address Line | 16458 BOLSA CHICA ST #234
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-2603
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Country | US
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Telephone | 714-917-9933
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | CRISTINA E FREESE
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Credential | L.C.S.W.
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Telephone | 714-917-9933
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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 | LCSW26653
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License Number State | CA
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