| NPI | 1366000945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHUGELLA WEAVER THOMAS Program Director 951-775-3748 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2019-06-17 |