Healthcare Provider Details

I. General information

NPI: 1568038131
Provider Name (Legal Business Name): MACIAS & MACIAS COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4193 FLAT ROCK DR.
RIVERSIDE CA
92505
US

IV. Provider business mailing address

PO BOX 49
NUEVO CA
92567
US

V. Phone/Fax

Practice location:
  • Phone: 909-294-6031
  • Fax:
Mailing address:
  • Phone: 909-294-6031
  • 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: MRS. NATALIE MACIAS-TORRES
Title or Position: DIRECTOR
Credential: LCSW
Phone: 909-294-6031