Provider Demographics
NPI:1467509968
Name:HARVILLE WASHINGTON, GWENDOLYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:
Last Name:HARVILLE WASHINGTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7828 HAVEN AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3049
Mailing Address - Country:US
Mailing Address - Phone:909-987-1647
Mailing Address - Fax:909-798-7909
Practice Address - Street 1:9089 BASELINE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1295
Practice Address - Country:US
Practice Address - Phone:909-210-5895
Practice Address - Fax:909-989-3932
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 221881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical