NPIMap

Organization Active NPI

Trauma and Healing Foundation

  • Marriage & Family Therapist
  • Fontana, CA
National Provider Identifier
1629600341
Registry record updated Dec 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
TRAUMA AND HEALING FOUNDATION
Practice address
17057 Foothill Blvd Ste 205
Fontana, CA 92335-3574
Phone
(909) 693-3177
Fax
(909) 693-3177
NPI assigned
Feb 11, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Carol R Adkisson, LMFTNPI 1386812170
Title
Ceo/Founder
Phone
(909) 693-3177

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X Primary

Addresses

Primary practice location

17057 Foothill Blvd Ste 205
Fontana, CA 92335-3574

Mailing address

17057 Foothill Blvd Ste 205
Fontana, CA 92335-3574
Phone (909) 693-3177

Other names 1

  • The Trauma and Healing Foundation Doing business as

National Provider Directory

National Provider Directory

Locations

17057 Foothill Blvd
Ste 205
Fontana, CA 92335
Phone (909) 660-3027

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1629600341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17057 FOOTHILL BLVD STE 205",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923353574",
            "telephone_number": "909-693-3177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17057 FOOTHILL BLVD STE 205",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923353574",
            "telephone_number": "909-693-3177",
            "fax_number": "909-693-3177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRAUMA AND HEALING FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-11",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A",
        "authorized_official_last_name": "ADKISSON",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO/FOUNDER",
        "authorized_official_telephone_number": "909-693-3177",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Trauma and Healing Foundation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fontana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.