Organization
LIFE SOURCE SOLUTIONS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AVIS C ATTAWAY LMFT (OWNER)
(951) 522-9370
Entity
Organization
Contact information
Practice address
4107 MISSION INN AVE, RIVERSIDE, CA 92501
(951) 682-7143
(951) 684-1135
Mailing address
PO BOX 529, RIVERSIDE, CA 92501
(951) 682-7143
(951) 684-1135
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
06/30/2009
Last updated
06/30/2009
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