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General NPI Number Information
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NPI Number | 1841709193
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Entity Type | Organization
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Legal Business Name | LIVING HOPE COUNSELING CENTER
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 11/24/2024
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Provider Practice Location Address
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Address Line | 9567 ARROW RTE STE M
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4550
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Country | US
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Telephone | 909-774-1137
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Fax | 855-215-1562
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Provider Business Mailing Address
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Address Line | 9567 ARROW RTE STE M
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4550
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Country | US
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Telephone | 909-774-1137
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Fax | 855-215-1562
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Authorized Official
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Title or Position | CEO
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Name | DR. YVONNE JACKSON
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Credential | DMFT, LMFT
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Telephone | 951-234-9555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | CA
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