Provider Demographics
NPI:1477095982
Name:OVERTON, LUCILLE (RADT-I)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:
Last Name:OVERTON
Suffix:
Gender:F
Credentials:RADT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E 6TH ST
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90021-1009
Mailing Address - Country:US
Mailing Address - Phone:213-700-5676
Mailing Address - Fax:
Practice Address - Street 1:515 E 6TH ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90021-1009
Practice Address - Country:US
Practice Address - Phone:213-700-5676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR38771214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)