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General NPI Number Information
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NPI Number | 1922793991
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE COUNSELING THERAPY
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Dates
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Enumeration Date | 04/06/2023
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Last Update Date | 04/06/2023
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Provider Practice Location Address
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Address Line | 4001 BIRCH ST STE B
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2265
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Country | US
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Telephone | 949-889-3867
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Fax |
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Provider Business Mailing Address
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Address Line | 15333 CULVER DR STE 340
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City | IRVINE
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State | CA
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Zip | 92604-3051
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Country | US
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Telephone | 949-889-3867
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINA BONNAFOUX
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Credential | LCSW
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Telephone | 949-889-3867
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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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