Individual
CHARLOTTE MODAHL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1601 BALL RD, #304, CYPRESS, CA 90630
(562) 431-8822
(562) 431-8875
Mailing address
3121 W COAST HWY, 3A, NEWPORT BEACH, CA 92663-4022
(949) 642-2041
(949) 642-2076
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY10375
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP103750
MEDICARE
—
Enumeration date
11/03/2009
Last updated
11/04/2010
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