Healthcare Provider Details

I. General information

NPI: 1871761882
Provider Name (Legal Business Name): TOTAL FAMILY SUPPORT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 CRENSHAW BLVD
LOS ANGELES CA
90019-6039
US

IV. Provider business mailing address

13741 FOOTHILL BLVD 270
SYLMAR CA
91342-3133
US

V. Phone/Fax

Practice location:
  • Phone: 818-883-9789
  • Fax: 818-833-9790
Mailing address:
  • Phone: 818-883-9789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: OLGA SKARLATO
Title or Position: CEO
Credential: PHD
Phone: 818-883-9789