Healthcare Provider Details

I. General information

NPI: 1568665743
Provider Name (Legal Business Name): EBONY ELIZABETH NORVILLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MASADA COMMUNITY MENTAL HEALTH SERVICES 314 E K4 SUITE 104
LANCASTER CA
93535
US

IV. Provider business mailing address

108 W VICTORIA ST
GARDENA CA
90248-3523
US

V. Phone/Fax

Practice location:
  • Phone: 661-726-5500
  • Fax:
Mailing address:
  • Phone: 310-715-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: