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General NPI Number Information
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NPI Number | 1184960478
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Entity Type | Organization
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Legal Business Name | DRK CO
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Dates
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Enumeration Date | 12/14/2012
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Last Update Date | 12/14/2012
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Provider Practice Location Address
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Address Line | 22930 CRENSHAW BLVD. STE A-2
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City | TORRANCE
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State | CA
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Zip | 90505
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Country | US
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Telephone | 323-345-4969
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Fax | 310-530-9475
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Provider Business Mailing Address
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Address Line | 1785 SAHARA AVE STE 490-983
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City | LOS VEGAS
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State | NV
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Zip | 89104
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Country | US
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Telephone | 800-829-4933
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Fax | 310-530-9475
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DIANA RUTH KRISHUN
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Credential | LCSW523CBD9511
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Telephone | 310-530-9475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5239511
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License Number State | CA
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