| NPI | 1124639489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA MARIE BULLARD Office Manager 323-347-8128 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2020-10-19 |