Provider Demographics
NPI:1255954558
Name:DIGNA RIVERA WOOLUM LICENSED CLINICAL SOCIAL WORKER INC A PROF
Entity type:Organization
Organization Name:DIGNA RIVERA WOOLUM LICENSED CLINICAL SOCIAL WORKER INC A PROF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DIGNA
Authorized Official - Middle Name:ROCIO
Authorized Official - Last Name:RIVERA WOOLUM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:661-390-6874
Mailing Address - Street 1:201 BROOKSIDE AVE.
Mailing Address - Street 2:#402
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-2517
Mailing Address - Country:US
Mailing Address - Phone:661-390-6874
Mailing Address - Fax:
Practice Address - Street 1:1255 W COLTON AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2861
Practice Address - Country:US
Practice Address - Phone:661-390-6874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA91473OtherBOARD OF BEHAVIORAL SCIENCES