Healthcare Provider Details

I. General information

NPI: 1376386888
Provider Name (Legal Business Name): TRIAD OF PEACE: COUPLES' COUNSELING & INDIVIDUAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28840 CAMARO DR
WINCHESTER CA
92596-8068
US

IV. Provider business mailing address

28840 CAMARO DR
WINCHESTER CA
92596-8068
US

V. Phone/Fax

Practice location:
  • Phone: 424-224-1998
  • Fax:
Mailing address:
  • Phone: 424-224-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CYNTHIA HAYNES
Title or Position: CEO
Credential: LMFT
Phone: 424-224-1998