Healthcare Provider Details

I. General information

NPI: 1447615539
Provider Name (Legal Business Name): NATIONAL COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE OF ESG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 N PARK AVE
POMONA CA
91768-3679
US

IV. Provider business mailing address

656 N PARK AVE
POMONA CA
91768-3679
US

V. Phone/Fax

Practice location:
  • Phone: 909-629-4084
  • Fax: 909-629-4086
Mailing address:
  • Phone: 909-629-4084
  • Fax: 909-629-4086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LYNETTA LOUISE HALE
Title or Position: SENIOR DIRECTOR, CLINICAL SERVICES
Credential: MA, LMFT, LPT
Phone: 626-332-3145