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General NPI Number Information
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NPI Number | 1194504480
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Entity Type | Organization
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Legal Business Name | CLINICAL SOCIAL WORK CORPORATION OF CALIFRONIA
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Dates
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Enumeration Date | 09/26/2023
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 13902 FIJI WAY APT 119
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6922
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Country | US
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Telephone | 909-515-3698
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Fax |
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Provider Business Mailing Address
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Address Line | 4712 ADMIRALTY WAY # 1011
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6905
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Country | US
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Telephone | 909-515-3698
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MELINDA G DRAKE
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Credential | LCSW, LISW CP & AP
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Telephone | 803-331-0865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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