Provider Demographics
NPI:1164715009
Name:FAMILY SERVICE ASSOCIATION
Entity Type:Organization
Organization Name:FAMILY SERVICE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOVER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-686-1096
Mailing Address - Street 1:21250 BOX SPRINGS ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-8705
Mailing Address - Country:US
Mailing Address - Phone:951-369-8036
Mailing Address - Fax:951-369-8303
Practice Address - Street 1:625 S PICO AVE
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-4130
Practice Address - Country:US
Practice Address - Phone:951-686-1096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health