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General NPI Number Information
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NPI Number | 1538617428
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Entity Type | Individual
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Provider Name | IMARI BILLY CHILDS LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/20/2016
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 4058 ORANGE AVE
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City | LONG BEACH
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State | CA
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Zip | 90807-3717
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Country | US
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Telephone | 310-362-4047
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Fax |
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Provider Business Mailing Address
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Address Line | 2905 LAKETON RD
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City | PITTSBURGH
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State | PA
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Zip | 15235-4154
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Country | US
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Telephone | 415-637-0232
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149018826
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License Number State | IL
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