| Kanita Bourne Licensed Clinical Social Worker Inc. | |
|
10601 Civic Center Dr # 100ad Rancho Cucamonga CA 91730-3878 | |
| (909) 520-7949 | |
| (909) 614-8012 |
| Full Name | Kanita Bourne Licensed Clinical Social Worker Inc. |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 10601 Civic Center Dr # 100ad, Rancho Cucamonga, California |
| Authorized Official Name and Position | Kanita Bourne (OWNER) |
| Authorized Official Contact | 9095207949 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kanita Bourne Licensed Clinical Social Worker Inc. 2910 S Archibald Ave Suite A #222 Ontario CA 91761 Ph: (909) 520-7949 | Kanita Bourne Licensed Clinical Social Worker Inc. 10601 Civic Center Dr # 100ad Rancho Cucamonga CA 91730-3878 Ph: (909) 520-7949 |
| NPI Number | 1861095671 |
|---|---|
| Provider Enumeration Date | 11/16/2020 |
| Last Update Date | 11/16/2020 |
| Certification Date | 11/16/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861095671 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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