MEDICARE: LAURIE LIN DALTON B.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1285965418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE LIN DALTON B.A.

Provider Business Mailing Address
First Line	:	2252 GRAND AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-2504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 S PACIFIC AVE
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90731-2656
Country	:	US
Telephone Number	:	310-519-8723
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2010
Last Update Date	:	03/24/2026

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