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Organization
NEWPORT BEACH TRAUMA THERAPY, INC
Active
Organization
NEWPORT BEACH TRAUMA THERAPY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAVVONNE WALLS (CEO)
(714) 457-7157
Entity
Organization
Contact information
Practice address
260 NEWPORT CENTER DR STE 206, NEWPORT BEACH, CA 92660-7520
(949) 545-8684
Mailing address
260 NEWPORT CENTER DR STE 206, NEWPORT BEACH, CA 92660-7520
(949) 545-8684
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
—
NULL
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
04/26/2021
Last updated
08/12/2021
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