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General NPI Number Information
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NPI Number | 1629408190
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Entity Type | Organization
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Legal Business Name | DOULOS COMMUNITY SERVICES
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Dates
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Enumeration Date | 11/20/2013
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Last Update Date | 11/20/2013
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Provider Practice Location Address
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Address Line | 9640 CENTER AVE SUITE 120
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5809
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Country | US
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Telephone | 909-996-7892
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Fax |
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Provider Business Mailing Address
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Address Line | 9640 CENTER AVE SUITE 120
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5809
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Country | US
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Telephone | 909-996-7892
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Fax |
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Authorized Official
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Title or Position | SECRETARY OFFICE MANAGER
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Name | MS. CATHERINE MARIE COOK
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Credential |
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Telephone | 909-996-7892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC39894
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY12904
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License Number State | CA
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