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General NPI Number Information
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NPI Number | 1174442107
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Entity Type | Individual
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Provider Name | ELLYJOY M AMOS II
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Gender | Female
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Dates
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Enumeration Date | 07/13/2026
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 3922 CANDLEWOOD ST 3922 3/4
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City | LAKEWOOD
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State | CA
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Zip | 90712
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Country | US
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Telephone | 310-987-8744
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Fax |
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Provider Business Mailing Address
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Address Line | 3922 3/4 CANDLEWOOD ST
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City | LAKEWOOD
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State | CA
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Zip | 90712-1640
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Country | US
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Telephone | 310-987-8744
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | VN727803
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License Number State | CA
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