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General NPI Number Information
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NPI Number | 1447579032
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Entity Type | Organization
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Legal Business Name | CUCAMONGA COUSELING AND BEHAVIORAL SOLUTIONS
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Dates
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Enumeration Date | 05/22/2010
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Last Update Date | 05/22/2010
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Provider Practice Location Address
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Address Line | 9333 BASELINE RD SUITE 150
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-1350
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Country | US
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Telephone | 951-751-2029
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 464
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City | ETIWANDA
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State | CA
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Zip | 91739-0464
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MRS. LENA M PAYNE
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Credential | LCSW, QCSW
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Telephone | 951-751-2029
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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 | 25874
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License Number State | CA
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