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General NPI Number Information
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NPI Number | 1962111690
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Entity Type | Organization
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Legal Business Name | OMNIA RECOVERY INC
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Dates
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Enumeration Date | 11/21/2022
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 1459 E THOUSAND OAKS BLVD STE D
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City | THOUSAND OAKS
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State | CA
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Zip | 91362-6221
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Country | US
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Telephone | 213-509-5190
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Fax |
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Provider Business Mailing Address
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Address Line | 5515 CANOGA AVE APT 321
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-6631
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Country | US
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Telephone | 213-509-5190
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALAN JOHNSONAVANESZADEH
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Credential |
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Telephone | 213-509-5190
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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