Healthcare Provider Details

I. General information

NPI: 1841566981
Provider Name (Legal Business Name): ARKADIE AND PAYNE, LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9587 ARROW RTE SUITE K
RANCHO CUCAMONGA CA
91730-4551
US

IV. Provider business mailing address

PO BOX 464
ETIWANDA CA
91739-0464
US

V. Phone/Fax

Practice location:
  • Phone: 909-962-7323
  • Fax:
Mailing address:
  • Phone: 909-962-7323
  • Fax: 909-962-7323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: LENA PAYNE
Title or Position: DIRECTOR
Credential: LCSW
Phone: 909-962-7323