Organization
COUNSELING CENTER OF SANTA MONICA - A PSYCHOLOGICAL CORPORATION
Active
Other names
Lake Detox
Organization subpart
No
Provider details
NPI number
Authorized official
REUBEN VAISMAN-TZACHOR (CLINICAL DIRECTOR)
(310) 477-6000
Entity
Organization
Contact information
Practice address
3611 LAKE CREST DR, LAKE ELSINORE, CA 92530-7982
(951) 457-2493
Mailing address
1731 BARRY AVE APT 112, LOS ANGELES, CA 90025-4090
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
03/27/2021
Last updated
03/27/2021
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