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General NPI Number Information
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NPI Number | 1992520001
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Entity Type | Individual
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Provider Name | NICOLE JOYNER PEER SUPPORT
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Gender |
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 3286 E GUASTI RD
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City | ONTARIO
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State | CA
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Zip | 91761-8645
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Country | US
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Telephone | 909-906-9844
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Fax |
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Provider Business Mailing Address
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Address Line | 2580 STATE ST
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City | CORONA
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State | CA
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Zip | 92881-4150
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Country | US
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Telephone | 801-651-4764
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MPSS-DHLENP
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License Number State | CA
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