Healthcare Provider Details

I. General information

NPI: 1063325892
Provider Name (Legal Business Name): KAMASHA WELLS-TITUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 W IMPERIAL HWY
LOS ANGELES CA
90047-5021
US

IV. Provider business mailing address

1841 W IMPERIAL HWY
LOS ANGELES CA
90047-5021
US

V. Phone/Fax

Practice location:
  • Phone: 323-448-1306
  • Fax:
Mailing address:
  • Phone: 323-448-1306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: