Healthcare Provider Details

I. General information

NPI: 1053221309
Provider Name (Legal Business Name): NATIONAL COUNCIL ON ALCOHOLISM & DRUG DEPENDENCE OF THE SAN FERNANDO V
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14407 HAMLIN ST STE B
VAN NUYS CA
91401-6200
US

IV. Provider business mailing address

6166 VESPER AVE
VAN NUYS CA
91411-2851
US

V. Phone/Fax

Practice location:
  • Phone: 818-997-0414
  • Fax: 818-785-3461
Mailing address:
  • Phone: 818-997-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAREN G MARDER
Title or Position: DIRECTOR OF CONTRACTS & QA
Credential: CADC II
Phone: 818-300-5540