Provider Demographics
NPI:1225310139
Name:TOKUSHIGE, FONDA (LCSW)
Entity Type:Individual
Prefix:
First Name:FONDA
Middle Name:
Last Name:TOKUSHIGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:FONDA
Other - Middle Name:
Other - Last Name:KIM-TOKUSHIGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:553 N PACIFIC COAST HWY
Mailing Address - Street 2:337B
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2163
Mailing Address - Country:US
Mailing Address - Phone:213-375-4605
Mailing Address - Fax:
Practice Address - Street 1:553 N PACIFIC COAST HWY
Practice Address - Street 2:337B
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2163
Practice Address - Country:US
Practice Address - Phone:213-375-4605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA654391041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical