Healthcare Provider Details

I. General information

NPI: 1538645866
Provider Name (Legal Business Name): LINDA BLACK HOWELL SUBSTANCE ABUSE COUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21505 NORWALK BLVD
HAWAIIAN GARDENS CA
90716-1121
US

IV. Provider business mailing address

21505 NORWALK BLVD
HAWAIIAN GARDENS CA
90716-1121
US

V. Phone/Fax

Practice location:
  • Phone: 562-916-7581
  • Fax: 562-916-7592
Mailing address:
  • Phone: 562-916-7581
  • Fax: 562-916-7592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCI3500315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: