Provider Demographics
NPI:1376674986
Name:HOWARD, DWIGHT DOUGLAS
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:DOUGLAS
Last Name:HOWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14128 CALVERT ST
Mailing Address - Street 2:APT.310
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-3473
Mailing Address - Country:US
Mailing Address - Phone:818-901-0436
Mailing Address - Fax:
Practice Address - Street 1:14128 CALVERT ST
Practice Address - Street 2:#310
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-3473
Practice Address - Country:US
Practice Address - Phone:818-901-4836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2015-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7420Medicaid
CA7068Medicaid