Organization
I CHOOSE LIFE ADDICTION SPECIALIST
Active
Other names
iCLASS Treatment Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RENALDO ROLANDO MOODIE JR. MFT (CLINICAL THERAPIST)
(951) 339-8443
Entity
Organization
Contact information
Practice address
425 E 6TH ST, UNIT 201, CORONA, CA 92879-1566
(951) 339-8443
(951) 339-8443
Mailing address
3380 LA SIERRA AVE, SUITE 104-730, RIVERSIDE, CA 92503-5271
(951) 339-8443
(951) 339-8443
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261Q00000X
Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
02/10/2015
Last updated
02/10/2015
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