Provider Demographics
NPI:1659786309
Name:CLOKE, AMITA (LPCC)
Entity Type:Individual
Prefix:
First Name:AMITA
Middle Name:
Last Name:CLOKE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8031 RALSTON PL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-6127
Mailing Address - Country:US
Mailing Address - Phone:951-300-3507
Mailing Address - Fax:
Practice Address - Street 1:10722 ARROW RTE
Practice Address - Street 2:SUITE 314
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4808
Practice Address - Country:US
Practice Address - Phone:951-300-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC320101Y00000X, 101YM0800X, 101YP2500X
CALEP3161101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool