Provider Demographics
NPI:1093268534
Name:GLENN L ABRAMS MARRIAGE, FAMILY, & CHILD COUNSELING INC.
Entity Type:Organization
Organization Name:GLENN L ABRAMS MARRIAGE, FAMILY, & CHILD COUNSELING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIC. MARRIAGE & FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ABRAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-718-9354
Mailing Address - Street 1:448 E FOOTHILL BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:448 E FOOTHILL BLVD STE 208
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1221
Practice Address - Country:US
Practice Address - Phone:909-718-9354
Practice Address - Fax:909-274-7207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCCI1279251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health