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General NPI Number Information
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NPI Number | 1063042851
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Entity Type | Organization
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Legal Business Name | MAKING A DIFFERENCE ASSOCIATION, INC.
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Dates
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Enumeration Date | 01/21/2020
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Last Update Date | 01/21/2020
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Provider Practice Location Address
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Address Line | 1430 E COOLEY DRIVE, STE 111
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City | COLTON
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State | CA
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Zip | 92324
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Country | US
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Telephone | 909-420-0413
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Fax | 909-510-0410
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Provider Business Mailing Address
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Address Line | 1430 E COOLEY DRIVE, STE 111
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City | COLTON
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State | CA
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Zip | 92324
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Country | US
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Telephone | 909-420-0413
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Fax | 909-510-0410
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TAMMY DE HESA
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Credential |
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Telephone | 909-420-0413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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