Healthcare Provider Details

I. General information

NPI: 1861007635
Provider Name (Legal Business Name): ANGELICA DARK PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14600 SHERMAN WAY STE 100D
VAN NUYS CA
91405
US

IV. Provider business mailing address

2601 AIRPORT DR STE 135
TORRANCE CA
90505-6141
US

V. Phone/Fax

Practice location:
  • Phone: 818-374-6901
  • Fax: 818-374-6908
Mailing address:
  • Phone: 424-201-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: