Healthcare Provider Details

I. General information

NPI: 1114620762
Provider Name (Legal Business Name): THE CENTER IN HOLLYWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6636 SELMA AVE
LOS ANGELES CA
90028-7115
US

IV. Provider business mailing address

6636 SELMA AVE
LOS ANGELES CA
90028-7115
US

V. Phone/Fax

Practice location:
  • Phone: 714-595-0771
  • Fax: 323-378-3224
Mailing address:
  • Phone: 714-595-0771
  • Fax: 323-378-3224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE C STELLINO
Title or Position: DIRECTOR OF PROGRAMS
Credential: ASW
Phone: 714-595-0771