Provider Demographics
NPI:1063101715
Name:LOCKED IN CEA INC.
Entity type:Organization
Organization Name:LOCKED IN CEA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KNIPSCHILD
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:951-394-1656
Mailing Address - Street 1:P.O. BOX 70665
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92513
Mailing Address - Country:US
Mailing Address - Phone:951-394-1656
Mailing Address - Fax:
Practice Address - Street 1:4937 SIERRA VISTA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505
Practice Address - Country:US
Practice Address - Phone:951-394-1656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOCKED IN CEA INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty