Basic Information
| Provider Information | |||||||||
| NPI: | 1265557599 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONNOLLEY | ||||||||
| FirstName: | OCEANIA | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5662 CALLE REAL | ||||||||
| Address2: | #142 | ||||||||
| City: | GOLETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931172317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057088824 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3230 WARING CT STE A | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920564509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603057528 | ||||||||
| FaxNumber: | 7605094410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 05/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 28897 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 28897 | 01 | CA | MFT | OTHER |