| NPI | 1780114835 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH ANN VANDENBOOM Owner 909-377-2616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2017-06-15 |