Provider Information for 1508182304
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KANIECIA LASHEA MIXON M.S.
Other Names:Former Name:KANIECIA LASHEA COOPER M.S., LMFTSex: Female
NPI: 1508182304
Last Updated: 2016-09-06
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||||||||
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| NPI | 1508182304 | ||||||||||||||||||||
| Enumeration Date | 2010-04-19 | ||||||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||||||
| Status | Active | ||||||||||||||||||||
| Mailing Address | 5198 ARLINGTON AVE # 106 RIVERSIDE, CA 92504-2603 United States Phone: 951-796-3621 | Fax: | ||||||||||||||||||||
| Primary Practice Address | 9500 HAVEN AVE STE 100 RANCHO CUCAMONGA, CA 91730-5871 United States Phone: 909-980-6700 | Fax: | ||||||||||||||||||||
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