Basic Information
| Provider Information | |||||||||
| NPI: | 1457493207 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AVILA | ||||||||
| FirstName: | A. | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1350 SUSAN AVE | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923742742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097933867 | ||||||||
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| Practice Location | |||||||||
| Address1: | 290 N 10TH ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | COLTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923243052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098256188 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 20393 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.