Healthcare Provider Details

I. General information

NPI: 1457268922
Provider Name (Legal Business Name): SOCIAL SKILLS TRAINING ACADEMY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6345 BALBOA BLVD STE 163
ENCINO CA
91316-5236
US

IV. Provider business mailing address

6345 BALBOA BLVD STE 163
ENCINO CA
91316-5236
US

V. Phone/Fax

Practice location:
  • Phone: 818-351-9520
  • Fax:
Mailing address:
  • Phone: 818-351-9520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. TAMMY MARIE VAN FLEET
Title or Position: CEO
Credential: PHD
Phone: 805-506-3390