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General NPI Number Information
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NPI Number | 1831237932
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Entity Type | Organization
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Legal Business Name | THE CAROLYN E. WYLIE CENTER FOR CHILDREN, YOUTH & FAMILIES
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4164 BROCKTON AVE
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City | RIVERSIDE
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State | CA
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Zip | 92501-3400
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Country | US
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Telephone | 951-683-5193
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Fax | 951-300-1030
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Provider Business Mailing Address
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Address Line | 4164 BROCKTON AVE
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City | RIVERSIDE
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State | CA
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Zip | 92501-3400
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Country | US
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Telephone | 951-683-5193
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Fax | 951-300-1030
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | PAMELA G JORDAN
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Credential | LCSW, MSLM
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Telephone | 951-683-5193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State | CA
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