Organization
EMPOWERED LIVING PSYCHOLOGICAL SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEFANIE LOCKHART-PETTAWAY PSY.D (CEO/ CLINICAL PSYCHOLOGIST)
(909) 652-0361
Entity
Organization
Contact information
Practice address
9113 FOOTHILL BLVD STE 130, RANCHO CUCAMONGA, CA 91730-6565
(909) 652-0361
(909) 652-0241
Mailing address
9113 FOOTHILL BLVD STE 130, RANCHO CUCAMONGA, CA 91730-6565
(909) 652-0361
(909) 652-0241
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
01/22/2019
Last updated
04/28/2021
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