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General NPI Number Information
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NPI Number | 1356925531
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Entity Type | Organization
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Legal Business Name | READY 4 CHANGE, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
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Dates
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Enumeration Date | 05/12/2021
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Last Update Date | 02/26/2023
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Provider Practice Location Address
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Address Line | 325 W HOSPITALITY LN STE 110
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3210
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Country | US
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Telephone | 909-581-4854
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Fax |
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Provider Business Mailing Address
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Address Line | 25920 IRIS AVE STE 13A #209
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City | MORENO VALLEY
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State | CA
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Zip | 92551-1658
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Country | US
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Telephone | 909-581-4854
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Fax | 951-405-6454
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Authorized Official
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Title or Position | AUTHORIZED REPRESENTATIVE
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Name | DR. MONIQUE ROACH
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Credential | LCSW
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Telephone | 909-581-4854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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