Healthcare Provider Details

I. General information

NPI: 1215695531
Provider Name (Legal Business Name): ANGELA THORNHILL LCSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 W FOOTHILL BLVD
UPLAND CA
91786-3676
US

IV. Provider business mailing address

2215 COLLETT AVE UNIT 407
CORONA CA
92879-8644
US

V. Phone/Fax

Practice location:
  • Phone: 909-396-0250
  • Fax:
Mailing address:
  • Phone: 951-378-9034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number99407
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: