| NPI | 1457963076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KHALIDA KHANUM Program Director 909-825-8080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2020-08-17 |