Individual
JERRY PINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.DIV., ED.S.
Contact information
Practice address
28545 FELIX VALDEZ AVE, SUITE B-1, TEMECULA, CA 92590-1859
(951) 240-5250
Mailing address
28545 FELIX VALDEZ AVE, SUITE B-1, TEMECULA, CA 92590-1859
(951) 240-5250
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
—
CA
103TS0200X
School Psychologist
—
CA
Other
Enumeration date
02/10/2009
Last updated
06/04/2009
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