Healthcare Provider Details

I. General information

NPI: 1093331753
Provider Name (Legal Business Name): DEANDREA KNIGHT LCSW INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W ALAMEDA AVE STE 300
BURBANK CA
91505-4153
US

IV. Provider business mailing address

4100 W ALAMEDA AVE STE 300
BURBANK CA
91505-4153
US

V. Phone/Fax

Practice location:
  • Phone: 818-600-2086
  • Fax:
Mailing address:
  • Phone: 818-600-2086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEANDREA KNIGHT
Title or Position: OWNER
Credential: LCSW
Phone: 310-492-3982