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General NPI Number Information
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NPI Number | 1811587231
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Entity Type | Individual
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Provider Name | AIMEE LYNNE HARVASTY RADT
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Gender | Female
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Dates
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Enumeration Date | 01/20/2021
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 20331 FLANAGAN RD.
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City | TRABUCO CANYON
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State | CA
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Zip | 92679-9267
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Country | US
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Telephone | 818-582-8832
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Fax |
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Provider Business Mailing Address
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Address Line | 19082 WOODWARD LN
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646-2319
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Country | US
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Telephone | 949-298-0374
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | R1411961220
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License Number State | CA
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