Provider Demographics
NPI:1679975452
Name:COUNSELING & SPIRITUAL CARE CENTER
Entity type:Organization
Organization Name:COUNSELING & SPIRITUAL CARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:562-445-4735
Mailing Address - Street 1:7342 ORANGETHORPE AVE STE B121
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-4547
Mailing Address - Country:US
Mailing Address - Phone:562-445-4735
Mailing Address - Fax:
Practice Address - Street 1:7342 ORANGETHORPE AVE STE B121
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-4547
Practice Address - Country:US
Practice Address - Phone:562-445-4735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPE37, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-23
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25323103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty