Healthcare Provider Details

I. General information

NPI: 1144879966
Provider Name (Legal Business Name): ALBA-WALKER LIFE STRATEGIES, A LICENSED CLINICAL SOCIAL WORKER CORPORA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 ROSCOE BLVD STE 400
PANORAMA CITY CA
91402-4194
US

IV. Provider business mailing address

14500 ROSCOE BLVD STE 400
PANORAMA CITY CA
91402-4194
US

V. Phone/Fax

Practice location:
  • Phone: 818-406-8543
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA ALBA
Title or Position: CEO
Credential: LCSW
Phone: 818-406-8543