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General NPI Number Information
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NPI Number | 1235854886
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Entity Type | Organization
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Legal Business Name | IGNTD, INC.
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Dates
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Enumeration Date | 10/06/2022
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Last Update Date | 04/19/2024
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Provider Practice Location Address
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Address Line | 4144 KENWAY AVE
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City | VIEW PARK
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State | CA
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Zip | 90008-4810
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Country | US
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Telephone | 310-488-3978
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Fax |
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Provider Business Mailing Address
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Address Line | 4144 KENWAY AVE
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City | VIEW PARK
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State | CA
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Zip | 90008-4810
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Country | US
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Telephone | 888-557-7217
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Fax | 888-739-6925
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Authorized Official
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Title or Position | CEO/EXECUTIVE DIRECTOR
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Name | ADI JAFFE
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Credential | PHD, ADC
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Telephone | 310-488-3978
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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 |
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License Number State |
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