Provider Demographics
NPI:1356486054
Name:AVALOS-MIRELES, GENOVEVA MARIA (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GENOVEVA
Middle Name:MARIA
Last Name:AVALOS-MIRELES
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2045
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91979-2045
Mailing Address - Country:US
Mailing Address - Phone:619-818-6533
Mailing Address - Fax:187-782-5946
Practice Address - Street 1:9628 CAMPO RD
Practice Address - Street 2:SUITE T
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-1245
Practice Address - Country:US
Practice Address - Phone:619-818-6533
Practice Address - Fax:187-782-5946
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 21116101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health