Organization
AVANT-GARDE COMMUNITY COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY ESTRAVIT (CEO)
(951) 735-5300
Entity
Organization
Contact information
Practice address
1655 E 6TH ST STE A5A, CORONA, CA 92879-1719
(951) 735-5300
(951) 735-9335
Mailing address
1655 E 6TH ST STE 117A5A, CORONA, CA 92879-1732
(951) 735-5300
(951) 735-9335
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MFC27861
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
659788
CORONA
CA
Enumeration date
09/22/2014
Last updated
09/23/2014
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