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General NPI Number Information
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NPI Number | 1902621642
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Entity Type | Organization
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Legal Business Name | COPING CABINET LICENSED CLINICAL SOCIAL WORKER
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 11340 W OLYMPIC BLVD STE 335
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City | LOS ANGELES
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State | CA
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Zip | 90064-1613
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Country | US
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Telephone | 562-607-5788
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Fax |
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Provider Business Mailing Address
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Address Line | 10425 CRENSHAW BLVD APT 5
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City | INGLEWOOD
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State | CA
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Zip | 90303-4462
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEAUJAHNE POLK
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Credential | LCSW
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Telephone | 562-607-5788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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