Healthcare Provider Details

I. General information

NPI: 1700850278
Provider Name (Legal Business Name): VALERIE WITHERSPOON PHD, RN, CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 OVERLAND AVE 8
CULVER CITY CA
90230-4995
US

IV. Provider business mailing address

5000 OVERLAND AVE 8
CULVER CITY CA
90230-4995
US

V. Phone/Fax

Practice location:
  • Phone: 310-838-2738
  • Fax: 310-838-2729
Mailing address:
  • Phone: 310-838-2738
  • Fax: 310-838-2729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY13838
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number319821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: