Provider Demographics
NPI:1619548542
Name:JOURNEY COUNSELING CENTER, INC
Entity Type:Organization
Organization Name:JOURNEY COUNSELING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOCCARDINI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:661-492-1521
Mailing Address - Street 1:PO BOX 6795
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-6795
Mailing Address - Country:US
Mailing Address - Phone:661-492-1521
Mailing Address - Fax:
Practice Address - Street 1:44709 DATE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3101
Practice Address - Country:US
Practice Address - Phone:661-492-1521
Practice Address - Fax:661-942-5195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)