Individual
LAURYN ANN SEALOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15217 SAN BERNARDINO AVE, FONTANA, CA 92335-5327
(951) 643-2150
Mailing address
2085 RUSTIN AVE STE 1, RIVERSIDE, CA 92507-2498
(951) 955-7320
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
167G00000X
Licensed Psychiatric Technician
Primary
PT42246
CA
Other
Enumeration date
09/08/2019
Last updated
02/14/2023
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