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General NPI Number Information
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NPI Number | 1750605143
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Entity Type | Organization
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Legal Business Name | L.A. CENTER FOR POSITIVE CHANGE, INC.
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Dates
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Enumeration Date | 03/15/2010
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 11924 W WASHINGTON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90066-4680
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Country | US
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Telephone | 310-390-9717
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Fax | 310-390-9717
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Provider Business Mailing Address
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Address Line | 11924 W WASHINGTON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90066-4680
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Country | US
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Telephone | 310-390-9717
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Fax | 310-390-9717
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. SUSAN K MICHAEL
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Credential | PSYD
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Telephone | 310-390-9717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 36631
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License Number State | CA
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