Provider Demographics
NPI:1396019832
Name:STOVALL, DENNIS
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:STOVALL
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 1:3221 N ALAMEDA ST
Mailing Address - Street 2:SUITE J & K
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90222-1433
Mailing Address - Country:US
Mailing Address - Phone:310-603-1098
Mailing Address - Fax:
Practice Address - Street 1:3221 N ALAMEDA ST
Practice Address - Street 2:SUITE J & K
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90222-1433
Practice Address - Country:US
Practice Address - Phone:310-603-1098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor