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General NPI Number Information
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NPI Number | 1972315257
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Entity Type | Organization
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Legal Business Name | ICLASS COUNSELING CENTER, INC.
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 1850 N RIVERSIDE AVE STE 110
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City | RIALTO
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State | CA
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Zip | 92376-8071
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Country | US
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Telephone | 213-878-1718
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Fax | 213-521-2030
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Provider Business Mailing Address
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Address Line | 3380 LASIERRA AVE 104-730
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City | RIVERSIDE
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State | CA
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Zip | 92503
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Country | US
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Telephone | 213-878-1718
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Fax | 213-521-2030
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | RENALDO R. MOODIE JR.
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Credential | LMFT
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Telephone | 909-379-4406
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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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