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General NPI Number Information
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NPI Number | 1629600341
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Entity Type | Organization
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Legal Business Name | TRAUMA AND HEALING FOUNDATION
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Dates
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Enumeration Date | 02/11/2020
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 17057 FOOTHILL BLVD STE 205
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City | FONTANA
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State | CA
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Zip | 92335-3574
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Country | US
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Telephone | 909-693-3177
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Fax | 909-693-3177
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Provider Business Mailing Address
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Address Line | 17057 FOOTHILL BLVD STE 205
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City | FONTANA
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State | CA
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Zip | 92335-3574
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Country | US
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Telephone | 909-693-3177
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | MS. CAROL R ADKISSON
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Credential | LMFT
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Telephone | 909-693-3177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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