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General NPI Number Information
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NPI Number | 1255954558
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Entity Type | Organization
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Legal Business Name | DIGNA RIVERA WOOLUM LICENSED CLINICAL SOCIAL WORKER INC A PROF
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Dates
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Enumeration Date | 05/20/2020
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 1255 W COLTON AVE
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City | REDLANDS
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State | CA
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Zip | 92374-2861
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Country | US
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Telephone | 661-390-6874
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Fax |
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Provider Business Mailing Address
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Address Line | 201 BROOKSIDE AVE. #402
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City | REDLANDS
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State | CA
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Zip | 92373-2517
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Country | US
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Telephone | 661-390-6874
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/PROVIDER
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Name | DIGNA ROCIO RIVERA WOOLUM
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Credential | LCSW
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Telephone | 661-390-6874
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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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