Healthcare Provider Details

I. General information

NPI: 1396656583
Provider Name (Legal Business Name): CHRISTINE'S GOOD LICENSED CLINICAL SOCIAL WORKER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 N CARMELITA AVE
LOS ANGELES CA
90063-3410
US

IV. Provider business mailing address

10316 SEPULVEDA BLVD # 406
MISSION HILLS CA
91345-2422
US

V. Phone/Fax

Practice location:
  • Phone: 510-305-6480
  • Fax: 510-743-7162
Mailing address:
  • Phone: 510-305-6480
  • Fax: 510-743-7162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE A VELASQUEZ
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LCSW
Phone: 510-305-6480