Organization
12 SOUTH LLC
Active
Other names
12 South Recovery
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE SMITH (CEO/OWNER)
(888) 830-8374
Entity
Organization
Contact information
Practice address
23712 BIRTCHER DRIVE, LAKE FOREST, CA 92630
(888) 830-8374
(949) 215-6650
Mailing address
23712 BIRTCHER DRIVE, LAKE FOREST, CA 92630
(714) 579-9304
(949) 215-6650
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
106H00000X
Marriage & Family Therapist
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
02/10/2016
Last updated
11/02/2022
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