Healthcare Provider Details

I. General information

NPI: 1477457067
Provider Name (Legal Business Name): WARREN G SPURLOCK JR. SUDCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6022 VARIEL AVE
WOODLAND HILLS CA
91367-3719
US

IV. Provider business mailing address

10406 LARWIN AVE
CHATSWORTH CA
91311-2058
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-1051
  • Fax:
Mailing address:
  • Phone: 818-996-1051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAII052180524
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: