Healthcare Provider Details

I. General information

NPI: 1912830308
Provider Name (Legal Business Name): C&C CENTER FOR HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W REDLANDS BLVD STE B
REDLANDS CA
92373-4642
US

IV. Provider business mailing address

501 W REDLANDS BLVD STE B
REDLANDS CA
92373-4642
US

V. Phone/Fax

Practice location:
  • Phone: 909-686-6233
  • Fax: 909-353-4985
Mailing address:
  • Phone: 715-559-9909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE CAMPOS
Title or Position: THERAPIST
Credential: ACSW
Phone: 626-559-7606