| NPI | 1073074209 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TA TANISHA JONES Licensed Psychologist, Director 951-505-4234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2023-12-07 |