Healthcare Provider Details

I. General information

NPI: 1134855778
Provider Name (Legal Business Name): COUNTY OF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

1000 S. FREMONT AVE, UNIT #9 BLDG A11 GROUND FL., SUITE A11010
ALHAMBRA CA
91803-8801
US

V. Phone/Fax

Practice location:
  • Phone: 424-306-6580
  • Fax:
Mailing address:
  • Phone: 626-525-6076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARMAINE DORSEY
Title or Position: DIRECTOR
Credential: LCSW, MSW
Phone: 213-288-9142