Provider Demographics
NPI:1770629214
Name:HARWICK, JOANNE ARDELL (MFT)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:ARDELL
Last Name:HARWICK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E GILBERT ST
Mailing Address - Street 2:COTTAGE #4
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-1003
Mailing Address - Country:US
Mailing Address - Phone:909-381-2420
Mailing Address - Fax:909-386-0775
Practice Address - Street 1:700 E GILBERT ST
Practice Address - Street 2:COTTAGE #4
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-1003
Practice Address - Country:US
Practice Address - Phone:909-381-2420
Practice Address - Fax:909-386-0775
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health