Healthcare Provider Details

I. General information

NPI: 1295953362
Provider Name (Legal Business Name): COMMUNITY ALCOHOL & DRUG FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15015 OXNARD ST.
VAN NUYS CA
91411-2613
US

IV. Provider business mailing address

15015 OXNARD ST.
VAN NUYS CA
91411-2613
US

V. Phone/Fax

Practice location:
  • Phone: 818-787-4151
  • Fax: 818-787-2840
Mailing address:
  • Phone: 818-787-4151
  • Fax: 818-787-2840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number190327AP
License Number StateCA

VIII. Authorized Official

Name: MS. ELIZABETH J MARCIAS
Title or Position: EXECUTIVE DIRECTOR
Credential: B.A. LIBERAL STUDIES
Phone: 818-787-4151