Provider Demographics
NPI:1376800706
Name:LEDWITZ, KAMILA (MS)
Entity Type:Individual
Prefix:MRS
First Name:KAMILA
Middle Name:
Last Name:LEDWITZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 N IRENA AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2221
Mailing Address - Country:US
Mailing Address - Phone:310-940-2869
Mailing Address - Fax:310-372-6280
Practice Address - Street 1:901 N PACIFIC COAST HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2162
Practice Address - Country:US
Practice Address - Phone:310-940-2869
Practice Address - Fax:310-372-6280
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39574101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health