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General NPI Number Information
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NPI Number | 1932328093
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Entity Type | Organization
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Legal Business Name | SOUTH OC WELLNESS
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 07/25/2008
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Provider Practice Location Address
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Address Line | 2730 CAMINO CAPISTRANO SUITE 3
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4847
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Country | US
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Telephone | 949-709-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 2730 CAMINO CAPISTRANO SUITE 3
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City | SAN CLEMENTE
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State | CA
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Zip | 92672
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Country | US
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Telephone | 949-709-7000
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARLA STONE
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Credential | LCSW
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Telephone | 949-709-7000
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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 | LCS21316
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License Number State | CA
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