| NPI | 1457800385 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KHALIDA KHANUM Program Director 909-825-8080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA LCSW28947) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA LCSW28841) |
| 106H00000X Marriage & Family Therapist (Licence: CA MFTI60442) | |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2016-10-04 |