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General NPI Number Information
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NPI Number | 1366250359
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Entity Type | Individual
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Provider Name | LORENE ASHLEY DEATLEY APCC
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Gender | Female
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Dates
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Enumeration Date | 12/21/2024
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Last Update Date | 12/21/2024
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Provider Practice Location Address
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Address Line | 150 W FOOTHILL BLVD UNIT A
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City | SAN DIMAS
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State | CA
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Zip | 91773-1103
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Country | US
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Telephone | 626-507-3585
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Fax |
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Provider Business Mailing Address
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Address Line | 319 MARIPOSA AVE APT C
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City | SIERRA MADRE
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State | CA
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Zip | 91024-2392
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Country | US
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Telephone | 760-490-4977
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 16787
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License Number State | CA
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