Provider Demographics
NPI:1710103304
Name:GARNETTE, DOROTHY R (LCSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:R
Last Name:GARNETTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 E CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6035
Mailing Address - Country:US
Mailing Address - Phone:909-421-7120
Mailing Address - Fax:909-421-7128
Practice Address - Street 1:18612 SANTA ANA AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:CA
Practice Address - Zip Code:92316-2636
Practice Address - Country:US
Practice Address - Phone:909-421-7120
Practice Address - Fax:909-421-7128
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12654324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility