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General NPI Number Information
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NPI Number | 1679185847
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Entity Type | Organization
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Legal Business Name | OPEN DOOR COUNSELING LICENSED CLINICAL SOCIAL WORKER AGENCIES INC
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Dates
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Enumeration Date | 08/19/2020
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Last Update Date | 08/19/2020
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Provider Practice Location Address
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Address Line | 436 W 4TH ST STE 220
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City | POMONA
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State | CA
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Zip | 91766-1623
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Country | US
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Telephone | 909-641-0846
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Fax | 909-694-0550
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Provider Business Mailing Address
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Address Line | 2026 N RIVERSIDE AVE STE C-193
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City | RIALTO
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State | CA
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Zip | 92377-4685
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Country | US
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Telephone | 909-641-0846
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Fax | 909-694-0550
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. FREDERICK SMITH
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Credential | MSW
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Telephone | 909-641-0846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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