Provider Demographics
NPI:1609387158
Name:ADVANTAGECARE, A LICENSED CLINICAL SOCIAL WORKER PC
Entity Type:Organization
Organization Name:ADVANTAGECARE, A LICENSED CLINICAL SOCIAL WORKER PC
Other - Org Name:PSYCHSOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:714-916-6668
Mailing Address - Street 1:419 MAIN ST STE 414
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5199
Mailing Address - Country:US
Mailing Address - Phone:714-916-6668
Mailing Address - Fax:
Practice Address - Street 1:419 MAIN ST STE 414
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5199
Practice Address - Country:US
Practice Address - Phone:714-916-6668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA704981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty