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General NPI Number Information
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NPI Number | 1639994361
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Entity Type | Organization
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Legal Business Name | RADIATE HOPE LICENSED PROFESSIONAL CLINICAL COUNSELOR, PC
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 12600 BRADDOCK DR APT 118
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City | LOS ANGELES
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State | CA
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Zip | 90066-6740
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Country | US
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Telephone | 909-501-4688
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Fax |
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Provider Business Mailing Address
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Address Line | 12600 BRADDOCK DR APT 118
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City | LOS ANGELES
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State | CA
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Zip | 90066-6740
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Country | US
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Telephone | 909-501-4688
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EMMANUEL GARCIA
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Credential | LPCC
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Telephone | 909-501-4688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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