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General NPI Number Information
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NPI Number | 1700530375
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Entity Type | Organization
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Legal Business Name | DTW MARRIAGE FAMILY CHILD COUNSELING SERVICES INC.
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Dates
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Enumeration Date | 02/11/2022
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 9431 HAVEN AVE STE 128
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5881
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Country | US
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Telephone | 951-330-5898
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Fax |
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Provider Business Mailing Address
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Address Line | 9431 HAVEN AVE STE 128
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5881
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Country | US
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Telephone | 951-330-5898
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DELSA TAPIA WILSON
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Credential | MS
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Telephone | 951-330-5898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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