Provider Demographics
NPI:1770887499
Name:FROM CHRYSALIS TO WINGS PSYCHOTHERAPY AND RESEARCH CENTER
Entity type:Organization
Organization Name:FROM CHRYSALIS TO WINGS PSYCHOTHERAPY AND RESEARCH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRIER-ZOREHKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:949-916-6852
Mailing Address - Street 1:30021 TOMAS STE 300
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2128
Mailing Address - Country:US
Mailing Address - Phone:949-916-6851
Mailing Address - Fax:949-916-6852
Practice Address - Street 1:27285 LAS RAMBLAS
Practice Address - Street 2:SUITE 232
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6325
Practice Address - Country:US
Practice Address - Phone:949-633-3995
Practice Address - Fax:949-916-6852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT47234106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty