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General NPI Number Information
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NPI Number | 1407991268
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Entity Type | Organization
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Legal Business Name | SAN BERNARDINO COUNTY DEPT. OF BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 290 N 10TH ST STE 102
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City | COLTON
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State | CA
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Zip | 92324-3052
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Country | US
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Telephone | 909-825-6188
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Fax | 909-872-0652
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Provider Business Mailing Address
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Address Line | 290 N 10TH ST STE 102
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City | COLTON
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State | CA
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Zip | 92324-3052
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Country | US
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Telephone | 909-825-6188
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Fax | 909-872-0652
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Authorized Official
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Title or Position | MENTAL HEALTH CLINICIAN III-D
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Name | MR. CHARLES GRAHAM BUCHANAN
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Credential | L.C.S.W.
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Telephone | 909-825-6188
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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 | 7007
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License Number State | CA
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