Healthcare Provider Details

I. General information

NPI: 1013696186
Provider Name (Legal Business Name): HERMANAS ADOLESCENT AND FAMILY WHOLISTIC COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3742 TIBBETTS ST STE 201
RIVERSIDE CA
92506-2641
US

IV. Provider business mailing address

3742 TIBBETTS ST STE 201
RIVERSIDE CA
92506-2641
US

V. Phone/Fax

Practice location:
  • Phone: 951-261-8217
  • Fax:
Mailing address:
  • Phone: 951-261-8217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIBEL ROBLES
Title or Position: CEO
Credential: LMFT
Phone: 951-261-8217