Healthcare Provider Details

I. General information

NPI: 1902017478
Provider Name (Legal Business Name): MICHAEL LEE MORIN CADC II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8604 LANKERSHIM BLVD
SUN VALLEY CA
91352-3140
US

IV. Provider business mailing address

433 RIVERDALE DR #22
GLENDALE CA
91204-1546
US

V. Phone/Fax

Practice location:
  • Phone: 818-768-1640
  • Fax: 818-768-1600
Mailing address:
  • Phone: 818-291-3370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA7460112
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number128289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: