Basic Information
| Provider Information | |||||||||
| NPI: | 1710103304 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARNETTE | ||||||||
| FirstName: | DOROTHY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 142 E CYPRESS AVE | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923736035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094217120 | ||||||||
| FaxNumber: | 9094217128 | ||||||||
| Practice Location | |||||||||
| Address1: | 18612 SANTA ANA AVE | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923162636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094217120 | ||||||||
| FaxNumber: | 9094217128 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| 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 | 324500000X | 12654 | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.