| NPI | 1366084360 |
|---|---|
| Former Legal Business Name | THERAVILLE COUNSELING SERVICES, A LICENSED CLINICAL SOCIAL WORKER CORP |
| Entity Type | Organization |
| Authorized Contact | CRYSTAL BURNS Owner/Clinician 909-767-3450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2019-10-10 |
| Last Update Date | 2021-11-04 |