| NPI | 1225515612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD R GRANT Facilitator 951-733-4977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 102594) |
| Enumeration Date | 2018-07-27 |
| Last Update Date | 2018-07-27 |