Healthcare Provider Details

I. General information

NPI: 1902621642
Provider Name (Legal Business Name): COPING CABINET LICENSED CLINICAL SOCIAL WORKER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11340 W OLYMPIC BLVD STE 335
LOS ANGELES CA
90064-1613
US

IV. Provider business mailing address

10425 CRENSHAW BLVD APT 5
INGLEWOOD CA
90303-4462
US

V. Phone/Fax

Practice location:
  • Phone: 562-607-5788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEAUJAHNE POLK
Title or Position: OWNER
Credential: LCSW
Phone: 562-607-5788