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General NPI Number Information
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NPI Number | 1699246272
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Entity Type | Organization
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Legal Business Name | CREATE REALISTIC CHANGE INC
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Dates
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Enumeration Date | 12/07/2018
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Last Update Date | 10/21/2019
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Provider Practice Location Address
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Address Line | 1873 W 54TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90062-2604
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Country | US
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Telephone | 424-222-1795
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Fax |
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Provider Business Mailing Address
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Address Line | 531 MAIN ST STE 1132
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City | EL SEGUNDO
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State | CA
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Zip | 90245-3060
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Country | US
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Telephone | 424-222-1795
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Fax |
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Authorized Official
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Title or Position | FOUNDER AND DIRECTOR
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Name | MS. CALIFIA ABWOON
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Credential | RECOVERY PRACTIONER
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Telephone | 424-222-1795
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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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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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