Healthcare Provider Details

I. General information

NPI: 1528405289
Provider Name (Legal Business Name): SINGLETON HOUSING PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5029 S VERMONT AVE TEEN CENTER
LOS ANGELES CA
90037-2907
US

IV. Provider business mailing address

1897 W JEFFERSON BLVD STE A
LOS ANGELES CA
90018-3434
US

V. Phone/Fax

Practice location:
  • Phone: 323-327-8677
  • Fax: 323-735-5387
Mailing address:
  • Phone: 323-730-0775
  • Fax: 323-735-5387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number190581AN
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number190581AN
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number190581AN
License Number StateCA

VIII. Authorized Official

Name: TONI YVONNE POWELL
Title or Position: PRESIDENT
Credential: MSW
Phone: 323-327-8677