Provider Demographics
NPI:1629852843
Name:DAMASK FAMILY COUNSELING AND CONSULTING CENTER
Entity Type:Organization
Organization Name:DAMASK FAMILY COUNSELING AND CONSULTING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/DOULA
Authorized Official - Prefix:
Authorized Official - First Name:STEFANY
Authorized Official - Middle Name:DEL CARMEN
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-455-2929
Mailing Address - Street 1:10339 DAMASK ROSE ST
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-3658
Mailing Address - Country:US
Mailing Address - Phone:909-455-2929
Mailing Address - Fax:760-974-4483
Practice Address - Street 1:10339 DAMASK ROSE ST
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-3658
Practice Address - Country:US
Practice Address - Phone:909-455-2929
Practice Address - Fax:760-974-4483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty