Organization
CAPTIVE HEARTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELISSA ROSE GOODENOUGH (BOARD MEMBER/ EMPLOYEE)
(805) 602-8751
Entity
Organization
Contact information
Practice address
882 W GRAND AVE, GROVER BEACH, CA 93433-2134
(805) 481-4500
Mailing address
882 W GRAND AVE, GROVER BEACH, CA 93433-2134
(805) 602-8751
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
101YP1600X
Pastoral Counselor
—
—
101YP2500X
Professional Counselor
—
—
103TR0400X
Rehabilitation Psychologist
—
—
172A00000X
Driver
—
—
Other
Enumeration date
06/05/2020
Last updated
06/17/2020
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