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General NPI Number Information
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NPI Number | 1851583439
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Entity Type | Organization
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Legal Business Name | DOMINION ALCOHOL & DRUG PROGRAM
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 08/16/2007
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Provider Practice Location Address
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Address Line | 5178 W PICO BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90019-4134
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Country | US
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Telephone | 323-933-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 5178 W. PICO BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90019-4134
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Country | US
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Telephone | 323-933-1800
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. MIESHA D PRICE
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Credential | MS
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Telephone | 323-933-1800
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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 | NONE
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License Number State | CA
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