Organization
SOCAL ADOLESCENT WELLNESS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA M HARRIS (CFO)
(949) 467-4324
Entity
Organization
Contact information
Practice address
22471 ASPAN ST STE 110, LAKE FOREST, CA 92630-1644
(714) 465-2305
Mailing address
16168 BEACH BLVD STE 170, HUNTINGTON BEACH, CA 92647-3878
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
10/25/2023
Last updated
10/25/2023
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