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General NPI Number Information
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NPI Number | 1073206975
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Entity Type | Organization
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Legal Business Name | DESIRED CHANGE THERAPEUTIC SOLUTIONS A LICENSED CLINICAL SOCIAL WORKER
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Dates
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Enumeration Date | 05/29/2023
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 822 S BREDEN LN
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City | RIALTO
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State | CA
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Zip | 92376-7829
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Country | US
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Telephone | 909-609-6078
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Fax |
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Provider Business Mailing Address
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Address Line | 1734 N RIVERSIDE AVE STE 1
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City | RIALTO
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State | CA
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Zip | 92376-8058
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Country | US
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Telephone | 909-329-3399
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DESERAE QUEZADA
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Credential | LCSW
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Telephone | 909-609-6078
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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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