Provider Demographics
NPI:1760126247
Name:REBUILDING FAMILY THERAPY
Entity Type:Organization
Organization Name:REBUILDING FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ESEOGHENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ONIWOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-644-6161
Mailing Address - Street 1:15218 SUMMIT AVE # 428
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0232
Mailing Address - Country:US
Mailing Address - Phone:855-723-2659
Mailing Address - Fax:
Practice Address - Street 1:2999 KENDALL DRIVE STE 204 PMB 1055
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407
Practice Address - Country:US
Practice Address - Phone:855-723-2659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty