MEDICARE: JHAVIA NICOLE BENJAMIN CADC-III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	B00002520722	CA

General Provider Information

NPI Number	:	1730890443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JHAVIA NICOLE BENJAMIN CADC-III

Provider Business Mailing Address
First Line	:	8300 S VERMONT AVE FL 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-3493
Country	:	US
Telephone Number	:	323-525-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	8300 S VERMONT AVE FL 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-3493
Country	:	US
Telephone Number	:	323-525-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2022
Last Update Date	:	01/22/2026

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