Provider Demographics
NPI:1164640686
Name:NZENWA, RICHARD YOUNG (AOD COUNSELOR)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:YOUNG
Last Name:NZENWA
Suffix:
Gender:M
Credentials:AOD COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:14623 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1581
Mailing Address - Country:US
Mailing Address - Phone:310-973-0100
Mailing Address - Fax:310-973-0099
Practice Address - Street 1:14623 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1581
Practice Address - Country:US
Practice Address - Phone:310-973-0100
Practice Address - Fax:310-973-0099
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACCBADC RS#5683101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)