| NPI | 1871277764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHADARIA R PRINCE Licensed Clinical Social Worker 310-654-9835 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0801X |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2023-07-07 |