Provider Demographics
NPI:1851663504
Name:WARD, AVIGAIL (LMFT)
Entity Type:Individual
Prefix:DR
First Name:AVIGAIL
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7019 SVL BOX
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5107
Mailing Address - Country:US
Mailing Address - Phone:760-885-0806
Mailing Address - Fax:760-596-1040
Practice Address - Street 1:14075 HESPERIA RD
Practice Address - Street 2:SUITE 105
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4500
Practice Address - Country:US
Practice Address - Phone:760-885-0806
Practice Address - Fax:760-596-1040
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51017106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist