| NPI | 1649990870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY C DE LA VEGA Marriage And Family Therapist 909-477-7005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2023-10-13 |