| NPI | 1982975009 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | CHARLES ELLIS President 909-576-2224  | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 5980-C)  | 
| Enumeration Date | 2012-01-20 | 
| Last Update Date | 2018-06-20 |