Healthcare Provider Details

I. General information

NPI: 1821110115
Provider Name (Legal Business Name): TOTAL FAMILY SUPPORT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 LONG BEACH BLVD
LONG BEACH CA
90806-3111
US

IV. Provider business mailing address

2511 LONG BEACH BLVD
LONG BEACH CA
90806-3111
US

V. Phone/Fax

Practice location:
  • Phone: 562-981-1501
  • Fax: 562-981-1502
Mailing address:
  • Phone: 562-981-1501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number2395299
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2395299
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number101YA0400X
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number101Y0000X
License Number StateCA

VIII. Authorized Official

Name: PAMELA JORDAN
Title or Position: PROGRAM MANAGER
Credential:
Phone: 323-778-4227