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General NPI Number Information
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NPI Number | 1578152179
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Entity Type | Organization
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Legal Business Name | TESTIMONIAL COMMUNITY LOVE CENTER
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Dates
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Enumeration Date | 01/18/2021
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Last Update Date | 01/18/2021
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Provider Practice Location Address
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Address Line | 5721 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90062-2714
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Country | US
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Telephone | 323-291-6753
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Fax |
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Provider Business Mailing Address
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Address Line | 5721 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90062-2714
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Country | US
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Telephone | 323-291-6753
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | MS. ZONEKE DOMINO
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Credential |
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Telephone | 504-495-2551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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