Provider Demographics
NPI:1396345898
Name:ARKADIE COUNSELING & WELLNESS CENTER PC LICENSED CLINICAL SOCIAL WORKE
Entity type:Organization
Organization Name:ARKADIE COUNSELING & WELLNESS CENTER PC LICENSED CLINICAL SOCIAL WORKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:LAVONNE
Authorized Official - Last Name:ARKADIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-614-4411
Mailing Address - Street 1:222 N MOUNTAIN AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5714
Mailing Address - Country:US
Mailing Address - Phone:909-614-4411
Mailing Address - Fax:909-494-5527
Practice Address - Street 1:222 N MOUNTAIN AVE STE 212
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5714
Practice Address - Country:US
Practice Address - Phone:909-614-4411
Practice Address - Fax:909-494-5527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty