| NPI | 1205393642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VAJEZATHA Z PAYNE Executive Director 310-200-6573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 102L00000X Psychoanalyst |
| Enumeration Date | 2019-02-21 |
| Last Update Date | 2019-02-21 |