Provider Demographics
NPI:1083633556
Name:LINDHOLM-CARDINALE, LAURA (MA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:LINDHOLM-CARDINALE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-2305
Mailing Address - Country:US
Mailing Address - Phone:714-357-0520
Mailing Address - Fax:714-459-7014
Practice Address - Street 1:1215 W IMPERIAL HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3738
Practice Address - Country:US
Practice Address - Phone:714-357-0520
Practice Address - Fax:714-459-7014
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34252106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist