Healthcare Provider Details

I. General information

NPI: 1154234789
Provider Name (Legal Business Name): ETHOS SHORELINE COUNSELING A MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8386 NUEVO AVE UNIT 4
FONTANA CA
92335-3565
US

IV. Provider business mailing address

16049 BASELINE AVE UNIT 1
FONTANA CA
92336-1830
US

V. Phone/Fax

Practice location:
  • Phone: 909-279-3608
  • Fax:
Mailing address:
  • Phone: 909-279-3608
  • Fax: 909-279-3608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOE MAC M POLLOCK JR.
Title or Position: CEO
Credential: LMFT
Phone: 909-279-3608