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General NPI Number Information
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NPI Number | 1043704331
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Entity Type | Organization
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Legal Business Name | CENTRAL COUNSELING SERVICES LICENSED CLINICAL SOCIAL WORKER INC
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Dates
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Enumeration Date | 06/19/2018
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 6840 INDIANA AVE STE 275
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City | RIVERSIDE
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State | CA
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Zip | 92506-4279
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Country | US
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Telephone | 951-778-0230
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Fax |
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Provider Business Mailing Address
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Address Line | 6840 INDIANA AVE STE 275
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City | RIVERSIDE
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State | CA
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Zip | 92506-4279
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Country | US
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Telephone | 951-778-0230
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATION OFFICER
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Name | SHERALYN L. SHOCKEY-POPE
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Credential | LMFT
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Telephone | 951-778-0230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 37209
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 26872
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License Number State | CA
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