Provider Demographics
NPI:1669003091
Name:OZIMOK, CAROLYN (LMFT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:OZIMOK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 LAWNDALE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4014
Mailing Address - Country:US
Mailing Address - Phone:562-708-6801
Mailing Address - Fax:
Practice Address - Street 1:13001 SEAL BEACH BLVD STE 360
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-2747
Practice Address - Country:US
Practice Address - Phone:562-708-6801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANONEOtherNONE