Organization
LAGUNA BEACH RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK RONALD KISNER MSW, CADC-II (CLINICAL DIRECTOR)
(714) 913-0852
Entity
Organization
Contact information
Practice address
316 THALIA ST, LAGUNA BEACH, CA 92651-2714
(866) 493-4527
(949) 497-3687
Mailing address
316 THALIA ST, LAGUNA BEACH, CA 92651-2714
(866) 493-4527
(949) 497-3687
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
300197AP
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300197AP
LICENSE/CERTIFICATION DRUG AND ALCOHOL
CA
Enumeration date
09/05/2008
Last updated
09/05/2008
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