Healthcare Provider Details

I. General information

NPI: 1376849257
Provider Name (Legal Business Name): CENTRAL COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3564 CENTRAL AVE. SUITE 2D
RIVERSIDE CA
92506-2705
US

IV. Provider business mailing address

3564 CENTRAL AVE. SUITE 2D
RIVERSIDE CA
92506-2705
US

V. Phone/Fax

Practice location:
  • Phone: 951-842-0365
  • Fax: 951-656-5554
Mailing address:
  • Phone: 951-842-0365
  • Fax: 951-656-5554

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: MS. SHERALYN LEE SHOCKEY-POPE
Title or Position: THERAPIST
Credential: LMFT
Phone: 951-842-0365