Provider Demographics
NPI:1295962850
Name:ASSOCIATES IN COUNSELING & MEDIATION
Entity type:Organization
Organization Name:ASSOCIATES IN COUNSELING & MEDIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN/SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABULONE
Authorized Official - Suffix:
Authorized Official - Credentials:MFC 33649
Authorized Official - Phone:714-978-1090
Mailing Address - Street 1:265 SOUTH ANITA AVE SUITE 117
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3341
Mailing Address - Country:US
Mailing Address - Phone:714-978-1090
Mailing Address - Fax:714-978-1087
Practice Address - Street 1:265 S. ANITA AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3341
Practice Address - Country:US
Practice Address - Phone:714-978-1090
Practice Address - Fax:714-978-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 4002607101YA0400X
CAMFC 15648106H00000X
CAMFC 33649106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300213APOtherDEPARTMENT OF ALCOHOL AND DRUG PROGRAM