Organization
DOULOS COMMUNITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CATHERINE MARIE COOK (SECRETARY OFFICE MANAGER)
(909) 996-7892
Entity
Organization
Contact information
Practice address
9640 CENTER AVE, SUITE 120, RANCHO CUCAMONGA, CA 91730-5809
(909) 996-7892
Mailing address
9640 CENTER AVE, SUITE 120, RANCHO CUCAMONGA, CA 91730-5809
(909) 996-7892
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY12904
CA
106H00000X
Marriage & Family Therapist
MFC39894
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPL129041
MEDICARE PTAN
CA
Enumeration date
11/20/2013
Last updated
11/20/2013
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