Provider Demographics
NPI:1710441993
Name:REDWOOD COUNSELING A LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CORP
Entity Type:Organization
Organization Name:REDWOOD COUNSELING A LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOBIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DESJARDINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:951-652-2600
Mailing Address - Street 1:132 S THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4351
Mailing Address - Country:US
Mailing Address - Phone:951-652-2600
Mailing Address - Fax:951-652-1101
Practice Address - Street 1:132 S THOMPSON ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4351
Practice Address - Country:US
Practice Address - Phone:951-652-2600
Practice Address - Fax:951-652-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty