Healthcare Provider Details

I. General information

NPI: 1912668187
Provider Name (Legal Business Name): RECONNECT MARRIAGE AND FAMILY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 01/10/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8949 LANGDON AVE. APT 39
NORTH HILLS CA
91343
US

IV. Provider business mailing address

1812 W BURBANK BLVD UNIT 853
BURBANK CA
91506-1315
US

V. Phone/Fax

Practice location:
  • Phone: 626-283-9680
  • 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: CYMONE NOEL DAMON-DAVID
Title or Position: VICE-PRESIDENT
Credential: LMFT
Phone: 626-283-9680