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General NPI Number Information
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NPI Number | 1861864118
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Entity Type | Organization
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Legal Business Name | ST. PAUL CENTER ALCOHOL AND DRUG PROGRAM
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 1039 W FLORENCE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90044-2441
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Country | US
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Telephone | 323-776-1504
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Fax |
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Provider Business Mailing Address
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Address Line | 1039 W FLORENCE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90044-2441
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Country | US
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Telephone | 323-779-1504
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | SHEILA CLAIBORNE
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Credential |
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Telephone | 310-908-3856
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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 | C1402211308
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License Number State | CA
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