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Organization
VIENNA PSYCHOLOGICAL GROUP, INC.
Active
Organization
VIENNA PSYCHOLOGICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLE MARIE VIENNA PSYD (VICE PRESIDENT & CLINICAL DIRECTOR)
(949) 290-3947
Entity
Organization
Contact information
Practice address
464 E BONITA AVE, SUITE 11, SAN DIMAS, CA 91773-3144
(626) 709-3494
Mailing address
464 E BONITA AVE, SUITE 11, SAN DIMAS, CA 91773-3144
(626) 709-3494
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
26945
CA
103TF0000X
Family Psychologist
26945
CA
103TF0200X
Forensic Psychologist
26945
CA
103TP2701X
Group Psychotherapy Psychologist
26945
CA
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
11/10/2015
Last updated
02/28/2017
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