Healthcare Provider Details

I. General information

NPI: 1447579032
Provider Name (Legal Business Name): CUCAMONGA COUSELING AND BEHAVIORAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2010
Last Update Date: 05/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 BASELINE RD SUITE 150
RANCHO CUCAMONGA CA
91730-1350
US

IV. Provider business mailing address

PO BOX 464
ETIWANDA CA
91739-0464
US

V. Phone/Fax

Practice location:
  • Phone: 951-751-2029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25874
License Number StateCA

VIII. Authorized Official

Name: MRS. LENA M PAYNE
Title or Position: PARTNER
Credential: LCSW, QCSW
Phone: 951-751-2029