Healthcare Provider Details

I. General information

NPI: 1396249421
Provider Name (Legal Business Name): MONICA LORENE CODY MA, CADC-II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12917 CERISE AVE
HAWTHORNE CA
90250-5520
US

IV. Provider business mailing address

447 E 131ST ST
LOS ANGELES CA
90061-2725
US

V. Phone/Fax

Practice location:
  • Phone: 310-675-4431
  • Fax:
Mailing address:
  • Phone: 310-662-1077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA053860219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: