Healthcare Provider Details

I. General information

NPI: 1881081362
Provider Name (Legal Business Name): CUCAMONGA COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9565 BUSINESS CENTER DR STE C
RANCHO CUCAMONGA CA
91730-4560
US

IV. Provider business mailing address

9565 BUSINESS CENTER DR STE C
RANCHO CUCAMONGA CA
91730-4560
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. NICOLE L ARKADIE
Title or Position: CHIEF OPERATING OFFICER
Credential: LCSW
Phone: 909-962-7323