Provider Demographics
NPI:1366250359
Name:DEATLEY, LORENE ASHLEY (APCC)
Entity type:Individual
Prefix:
First Name:LORENE
Middle Name:ASHLEY
Last Name:DEATLEY
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 MARIPOSA AVE APT C
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2392
Mailing Address - Country:US
Mailing Address - Phone:760-490-4977
Mailing Address - Fax:
Practice Address - Street 1:150 W FOOTHILL BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1103
Practice Address - Country:US
Practice Address - Phone:626-507-3585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-21
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16787101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional