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General NPI Number Information
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NPI Number | 1750028908
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Entity Type | Organization
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Legal Business Name | 180 URBAN COUNSELING LICENSED CLINICAL SOCIAL WORK CORP.
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 4508 ATLANTIC AVE STE A517
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City | LONG BEACH
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State | CA
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Zip | 90807-1520
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Country | US
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Telephone | 202-681-2660
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Fax | 562-512-6337
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Provider Business Mailing Address
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Address Line | 4508 ATLANTIC AVE STE A517
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City | LONG BEACH
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State | CA
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Zip | 90807-1520
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Country | US
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Telephone | 202-681-2660
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Fax | 562-512-6337
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KELIA PARKER
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Credential | LCSW
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Telephone | 202-681-2660
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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