Healthcare Provider Details

I. General information

NPI: 1639931405
Provider Name (Legal Business Name): VEATRICE HARRELL RADT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 S INDIANA ST
LOS ANGELES CA
90063-3908
US

IV. Provider business mailing address

6022 VARIEL AVE
WOODLAND HILLS CA
91367-3719
US

V. Phone/Fax

Practice location:
  • Phone: 323-266-7726
  • Fax:
Mailing address:
  • Phone: 818-996-1051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17069
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: