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General NPI Number Information
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NPI Number | 1467992750
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Entity Type | Individual
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Provider Name | DONNA LEDET-WILLIS
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Gender | Female
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Dates
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Enumeration Date | 03/06/2017
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 4335 ATLANTIC AVE
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City | LONG BEACH
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State | CA
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Zip | 90807-2803
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Country | US
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Telephone | 522-216-4900
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Fax | 526-416-1516
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Provider Business Mailing Address
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Address Line | 11514 ELVINS ST
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City | LAKEWOOD
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State | CA
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Zip | 90715-1218
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Country | US
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Telephone | 562-225-5900
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | VN189282
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License Number State | CA
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