Individual
EBONY RENE VENABLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
1481 WINDSOR DR, SAN BERNARDINO, CA 92404-5416
(909) 361-6472
(909) 203-7403
Mailing address
3572 BANBURY DR APT 31, RIVERSIDE, CA 92505-1928
(909) 361-6472
(909) 203-7403
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
34496
CA
Other
Enumeration date
03/23/2020
Last updated
03/23/2020
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