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General NPI Number Information
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NPI Number | 1144620477
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Entity Type | Individual
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Provider Name | LENA MAGARDECHIAN M.A.
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Gender | Female
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Dates
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Enumeration Date | 08/22/2014
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Last Update Date | 08/22/2014
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Provider Practice Location Address
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Address Line | 11777 SEBASTIAN WAY STE AAND102B (909) 989-9724
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0707
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Country | US
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Telephone | 909-989-9724
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Fax |
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Provider Business Mailing Address
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Address Line | 1443 E BROADWAY UNIT B
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City | GLENDALE
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State | CA
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Zip | 91205-1530
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Country | US
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Telephone | 818-970-5452
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 71891
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License Number State | CA
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