Healthcare Provider Details

I. General information

NPI: 1851663504
Provider Name (Legal Business Name): AVIGAIL WARD LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14075 HESPERIA RD SUITE 105
VICTORVILLE CA
92395-4500
US

IV. Provider business mailing address

7019 SVL BOX
VICTORVILLE CA
92395-5107
US

V. Phone/Fax

Practice location:
  • Phone: 760-885-0806
  • Fax: 760-596-1040
Mailing address:
  • Phone: 760-885-0806
  • Fax: 760-596-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number51017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: