Provider Demographics
NPI:1174957740
Name:STOLAR-PETERSON, NICOL ALEJANDRA (LCSW)
Entity type:Individual
Prefix:
First Name:NICOL
Middle Name:ALEJANDRA
Last Name:STOLAR-PETERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27890 CLINTON KEITH ROAD, #D-303
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562
Mailing Address - Country:US
Mailing Address - Phone:310-422-4575
Mailing Address - Fax:
Practice Address - Street 1:3564 CENTRAL AVE STE 2D
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2705
Practice Address - Country:US
Practice Address - Phone:310-422-4575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS260511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical