Basic Information
| Provider Information | |||||||||
| NPI: | 1265949564 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HD CHRISTIAN FAMILY COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14420 CIVIC DR STE 4 | ||||||||
| Address2: | |||||||||
| City: | VICTORVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923922384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604900109 | ||||||||
| FaxNumber: | 7607801561 | ||||||||
| Practice Location | |||||||||
| Address1: | 14420 CIVIC DR STE 4 | ||||||||
| Address2: | |||||||||
| City: | VICTORVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923922384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604900109 | ||||||||
| FaxNumber: | 7607801561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2018 | ||||||||
| LastUpdateDate: | 01/08/2018 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | NYSHIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER, CEO | ||||||||
| AuthorizedOfficialTelephone: | 7604900109 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP1600X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Pastoral | 103TC0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 106H00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 1041C0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.