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General NPI Number Information
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NPI Number | 1467103846
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Entity Type | Organization
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Legal Business Name | KARISA QUICK LICENSED PROFESSIONAL CLINICAL COUNSELOR
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Dates
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Enumeration Date | 01/17/2022
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 5083 COLUMBIA DR
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City | FONTANA
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State | CA
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Zip | 92336-0617
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Country | US
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Telephone | 909-808-9607
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Fax |
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Provider Business Mailing Address
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Address Line | 5083 COLUMBIA DR
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City | FONTANA
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State | CA
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Zip | 92336-0617
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Country | US
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Telephone | 909-808-9607
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | KARISA NICOLE QUICK
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Credential | LPCC
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Telephone | 909-808-9607
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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 |
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License Number State |
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