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General NPI Number Information
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NPI Number | 1700159704
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Entity Type | Organization
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Legal Business Name | SOUTH BAY COUNSELING & SOCIAL SERVICES
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 24328 S. VERMONT AVE. STE. 212
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City | HARBOR CITY
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State | CA
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Zip | 90710
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Country | US
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Telephone | 310-530-9097
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Fax | 310-530-9097
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Provider Business Mailing Address
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Address Line | 24328 S. VERMONT AVE. STE. 212
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City | HARBOR CITY
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State | CA
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Zip | 90710
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Country | US
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Telephone | 310-530-9097
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Fax | 310-530-9097
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Authorized Official
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Title or Position | OWNER
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Name | MISS SHERRY J. GLOVER
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Credential | LCSW
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Telephone | 310-530-9097
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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 | LCS23563
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License Number State | CA
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