Healthcare Provider Details

I. General information

NPI: 1821278045
Provider Name (Legal Business Name): HELEN JOYCE VAN DAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1538 HOWARD ACCESS RD STE B
UPLAND CA
91786-2581
US

IV. Provider business mailing address

3401 CUTTING HORSE RD
NORCO CA
92860-5108
US

V. Phone/Fax

Practice location:
  • Phone: 909-635-8077
  • Fax:
Mailing address:
  • Phone: 951-582-0382
  • Fax: 951-582-0382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS10127
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: