Provider Demographics
NPI:1932328093
Name:SOUTH OC WELLNESS
Entity Type:Organization
Organization Name:SOUTH OC WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:949-709-7000
Mailing Address - Street 1:2730 CAMINO CAPISTRANO
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672
Mailing Address - Country:US
Mailing Address - Phone:949-709-7000
Mailing Address - Fax:
Practice Address - Street 1:2730 CAMINO CAPISTRANO
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4847
Practice Address - Country:US
Practice Address - Phone:949-709-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS213161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty