Healthcare Provider Details

I. General information

NPI: 1194863969
Provider Name (Legal Business Name): RIVERSIDE COUNTY, DEPARTMENT OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 LEMON ST STE 205
RIVERSIDE CA
92501-3608
US

IV. Provider business mailing address

4275 LEMON ST STE 205
RIVERSIDE CA
92501-3608
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-4545
  • Fax:
Mailing address:
  • Phone: 951-955-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberLCSW72861
License Number StateCA

VIII. Authorized Official

Name: MRS. ADRIENNE SHANETTE CHADWICK
Title or Position: CTII
Credential: LCSW
Phone: 951-955-4545