Provider Demographics
NPI:1679185847
Name:OPEN DOOR COUNSELING LICENSED CLINICAL SOCIAL WORKER AGENCIES INC
Entity Type:Organization
Organization Name:OPEN DOOR COUNSELING LICENSED CLINICAL SOCIAL WORKER AGENCIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:909-641-0846
Mailing Address - Street 1:2026 N RIVERSIDE AVE STE C-193
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-4685
Mailing Address - Country:US
Mailing Address - Phone:909-641-0846
Mailing Address - Fax:909-694-0550
Practice Address - Street 1:436 W 4TH ST STE 220
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-1623
Practice Address - Country:US
Practice Address - Phone:909-641-0846
Practice Address - Fax:909-694-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty