Healthcare Provider Details

I. General information

NPI: 1093400095
Provider Name (Legal Business Name): LOVE THYSELF SOCIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S. BARRINGTON AVE. STE. 215
LA CA
90025
US

IV. Provider business mailing address

2211 4TH ST APT 203
SANTA MONICA CA
90405-2361
US

V. Phone/Fax

Practice location:
  • Phone: 855-588-7353
  • Fax:
Mailing address:
  • Phone: 323-572-9923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KESIA CARTER
Title or Position: MENTAL HEALTH PROFESSIONAL
Credential: LCSW
Phone: 323-572-9923