Provider Demographics
NPI:1356925531
Name:READY 4 CHANGE, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity type:Organization
Organization Name:READY 4 CHANGE, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:DR
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:909-581-4854
Mailing Address - Street 1:25920 IRIS AVE
Mailing Address - Street 2:STE 13A #209
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-1658
Mailing Address - Country:US
Mailing Address - Phone:909-581-4854
Mailing Address - Fax:951-405-6454
Practice Address - Street 1:325 W HOSPITALITY LN STE 110
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3210
Practice Address - Country:US
Practice Address - Phone:909-581-4854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health