| Doctor Name: | MR. ANTHONIE ONTREAY ETIENNE |
| NPI Number: | 1023428117 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | PCCI2213 |
| Business Practice Address: | 251 Llewellyn Ave Campbell, CA - 950081940 |
| Business Phone Number: | 4083793790 |
| Business Fax Number: | |
| Mailing Address: | 572 N Arrowhead Ave, Suite 200 SAN BERNARDINO |
| State: | CA |
| Postal Code: | 924011251 |
| Phone Number: | 9092662700 |
| Fax Number: | |
| NPI Enumeration Date: | 04/29/2014 |
| NPI Last Update Date: | 05/04/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | PCCI2213 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |