Provider Demographics
NPI:1972315257
Name:ICLASS COUNSELING CENTER, INC.
Entity type:Organization
Organization Name:ICLASS COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RENALDO
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOODIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-379-4406
Mailing Address - Street 1:3380 LASIERRA AVE 104-730
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503
Mailing Address - Country:US
Mailing Address - Phone:213-878-1718
Mailing Address - Fax:213-521-2030
Practice Address - Street 1:1850 N RIVERSIDE AVE STE 110
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8071
Practice Address - Country:US
Practice Address - Phone:213-878-1718
Practice Address - Fax:213-521-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-23
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty