Individual
AMANDA GRACE LAZO QAQISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT, PPS
Contact information
Practice address
26087 ARROYO LN, LOMA LINDA, CA 92354-6520
(626) 827-2218
Mailing address
26087 ARROYO LN, LOMA LINDA, CA 92354-6520
(626) 827-2218
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
102948
CA
Other
Enumeration date
12/29/2014
Last updated
05/15/2024
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