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General NPI Number Information
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NPI Number | 1639690449
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Entity Type | Organization
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Legal Business Name | DYNAMIC TRANSFORMATIONS
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Dates
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Enumeration Date | 06/30/2017
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Last Update Date | 06/30/2017
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Provider Practice Location Address
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Address Line | 1247 CANTANIA DR
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City | REDLANDS
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State | CA
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Zip | 92374-4748
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Country | US
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Telephone | 800-417-0485
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Fax | 909-335-2804
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Provider Business Mailing Address
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Address Line | 101 E REDLANDS BLVD STE 200
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City | REDLANDS
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State | CA
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Zip | 92373-4724
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Country | US
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Telephone | 800-417-0485
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GARY HITCHCOCK
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Credential | CADC - CAS
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Telephone | 949-280-6166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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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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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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