| Thespacebetweencounselingserviceslicensedclinicalsocialworkerinc | |
|
12139 Mount Vernon Ave Ste 200a Grand Terrace CA 92313-5547 | |
| (951) 465-5812 | |
| (951) 346-5680 |
| Full Name | Thespacebetweencounselingserviceslicensedclinicalsocialworkerinc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 12139 Mount Vernon Ave Ste 200a, Grand Terrace, California |
| Authorized Official Name and Position | Zuelika C Xicotencatl (LCSW) |
| Authorized Official Contact | 9514655812 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Thespacebetweencounselingserviceslicensedclinicalsocialworkerinc 12139 Mount Vernon Ave Ste 200a Grand Terrace CA 92313-5547 Ph: (951) 465-5812 | Thespacebetweencounselingserviceslicensedclinicalsocialworkerinc 12139 Mount Vernon Ave Ste 200a Grand Terrace CA 92313-5547 Ph: (951) 465-5812 |
| NPI Number | 1457948077 |
|---|---|
| Provider Enumeration Date | 12/29/2020 |
| Last Update Date | 12/29/2020 |
| Certification Date | 12/29/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457948077 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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