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General NPI Number Information
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NPI Number | 1033779343
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Entity Type | Organization
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Legal Business Name | YOUTH HOPE LICENSED CLINICAL SOCIAL WORKER CORP
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 255 N D ST STE 400
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City | SAN BERNARDINO
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State | CA
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Zip | 92401-1715
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Country | US
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Telephone | 909-567-2808
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 264
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City | PATTON
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State | CA
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Zip | 92369-0264
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Country | US
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Telephone | 909-567-2808
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | CECILIA DE LORENZO
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Credential |
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Telephone | 909-567-2808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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