Provider Demographics
NPI:1255816898
Name:COUNSELING ASSOCIATES OF THE SOUTHLAND INC
Entity type:Organization
Organization Name:COUNSELING ASSOCIATES OF THE SOUTHLAND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:PECK-SOBOLEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:626-367-6269
Mailing Address - Street 1:680 LANGSDORF DR STE 209
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3702
Mailing Address - Country:US
Mailing Address - Phone:714-578-0990
Mailing Address - Fax:714-449-9252
Practice Address - Street 1:680 LANGSDORF DR STE 219
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3702
Practice Address - Country:US
Practice Address - Phone:714-578-0990
Practice Address - Fax:714-449-9252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-29
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)