Provider Demographics
NPI:1023381761
Name:KALAGHICHIAN, KIANA (LCSW67830)
Entity Type:Individual
Prefix:MRS
First Name:KIANA
Middle Name:
Last Name:KALAGHICHIAN
Suffix:
Gender:F
Credentials:LCSW67830
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 ORANGE ST STE 8
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4719
Mailing Address - Country:US
Mailing Address - Phone:951-288-9086
Mailing Address - Fax:909-363-8020
Practice Address - Street 1:108 ORANGE ST STE 8
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373
Practice Address - Country:US
Practice Address - Phone:951-288-9086
Practice Address - Fax:909-363-8020
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA678301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7725941Medicaid