Healthcare Provider Details

I. General information

NPI: 1831840123
Provider Name (Legal Business Name): NLA LICENSED CLINICAL SOCIAL WORKER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 S ROBERTSON BLVD STE 105
LOS ANGELES CA
90035-1600
US

IV. Provider business mailing address

902 S HOLT AVE
LOS ANGELES CA
90035-2008
US

V. Phone/Fax

Practice location:
  • Phone: 347-885-9227
  • Fax:
Mailing address:
  • Phone: 134-788-5922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NAOMI LEWIS AFRIAT
Title or Position: OWNER
Credential: LCSW
Phone: 347-885-9227