Provider Demographics
NPI:1164786851
Name:SAGE COUNSELING SERVICES, INC
Entity Type:Organization
Organization Name:SAGE COUNSELING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA CARLA
Authorized Official - Middle Name:GOMES
Authorized Official - Last Name:LAIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-538-4421
Mailing Address - Street 1:18411 CRENSHAW BLVD
Mailing Address - Street 2:SUITE 413
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5042
Mailing Address - Country:US
Mailing Address - Phone:310-358-4421
Mailing Address - Fax:323-843-9371
Practice Address - Street 1:18411 CRENSHAW BLVD
Practice Address - Street 2:SUITE 413
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-5042
Practice Address - Country:US
Practice Address - Phone:310-358-4421
Practice Address - Fax:323-843-9371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44112106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty