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General NPI Number Information
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NPI Number | 1124490446
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Entity Type | Organization
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Legal Business Name | VICTORVILLE COUNSELING
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Dates
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Enumeration Date | 10/26/2015
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 15431 ANACAPA RD SUITE # D
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City | VICTORVILLE
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State | CA
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Zip | 92392
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Country | US
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Telephone | 951-333-7363
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Fax | 760-240-3728
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Provider Business Mailing Address
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Address Line | 15431 ANACAPA RD SUITE # D
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City | VICTORVILLE
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State | CA
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Zip | 92392
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Country | US
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Telephone | 951-333-7363
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Fax | 760-240-3728
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Authorized Official
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Title or Position | CLINICIAN
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Name | DR. MAYADA MARZOUK
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Credential | LMFT
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Telephone | 951-333-7363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | MFC # 53104
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MFC # 53104
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License Number State | CA
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