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General NPI Number Information
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NPI Number | 1124789268
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Entity Type | Organization
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Legal Business Name | DEVELOP ACHIEVE SUCCEED
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Dates
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Enumeration Date | 12/30/2021
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 1225 W 190TH ST # 455G
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City | GARDENA
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State | CA
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Zip | 90248-4320
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Country | US
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Telephone | 562-965-6782
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Fax |
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Provider Business Mailing Address
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Address Line | 9835 FLOWER ST UNIT 1523
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City | BELLFLOWER
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State | CA
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Zip | 90707-7074
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Country | US
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Telephone | 562-965-6782
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | DIVINITY SARDIN
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Credential | LCSW
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Telephone | 562-965-6782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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