Provider Demographics
NPI:1982197547
Name:CITRUS CREST FAMILY COUNSELING INC.
Entity Type:Organization
Organization Name:CITRUS CREST FAMILY COUNSELING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:HILLE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMFT
Authorized Official - Phone:951-565-0946
Mailing Address - Street 1:16842 STALLION PL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-5845
Mailing Address - Country:US
Mailing Address - Phone:951-565-0946
Mailing Address - Fax:951-398-7438
Practice Address - Street 1:16801 VAN BUREN BLVD STE 214
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-5893
Practice Address - Country:US
Practice Address - Phone:951-565-0946
Practice Address - Fax:951-398-7438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48095251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health