Healthcare Provider Details

I. General information

NPI: 1083579015
Provider Name (Legal Business Name): JUSTIN FEARRINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 OCEAN FRONT WALK
VENICE CA
90291-2403
US

IV. Provider business mailing address

624 1/2 N GARFIELD AVE
MONTEBELLO CA
90640-1641
US

V. Phone/Fax

Practice location:
  • Phone: 310-392-3070
  • Fax:
Mailing address:
  • Phone: 310-392-3070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: