Provider Demographics
NPI:1629600341
Name:TRAUMA AND HEALING FOUNDATION
Entity Type:Organization
Organization Name:TRAUMA AND HEALING FOUNDATION
Other - Org Name:THE TRAUMA AND HEALING FOUNDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ADKISSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-693-3177
Mailing Address - Street 1:17057 FOOTHILL BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3574
Mailing Address - Country:US
Mailing Address - Phone:909-693-3177
Mailing Address - Fax:
Practice Address - Street 1:17057 FOOTHILL BLVD STE 205
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3574
Practice Address - Country:US
Practice Address - Phone:909-693-3177
Practice Address - Fax:909-693-3177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty