Provider Demographics
NPI:1376180141
Name:BARBER, JONATHAN (CADC-CAS)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:BARBER
Suffix:
Gender:M
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9705 HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-3031
Mailing Address - Country:US
Mailing Address - Phone:323-249-9097
Mailing Address - Fax:323-249-9121
Practice Address - Street 1:9705 HOLMES AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-3031
Practice Address - Country:US
Practice Address - Phone:323-249-9097
Practice Address - Fax:323-249-9121
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-29
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)