Provider Demographics
NPI:1477798098
Name:CALIFORNIA DEPARTMENT OF MENTAL HEALTH
Entity Type:Organization
Organization Name:CALIFORNIA DEPARTMENT OF MENTAL HEALTH
Other - Org Name:AUGUSTUS F. HAWKINS
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOLOGY EXTERN
Authorized Official - Prefix:MISS
Authorized Official - First Name:SEAAIRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:REEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-869-3452
Mailing Address - Street 1:8600 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-4828
Mailing Address - Country:US
Mailing Address - Phone:310-869-3452
Mailing Address - Fax:
Practice Address - Street 1:8600 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-4828
Practice Address - Country:US
Practice Address - Phone:310-869-3452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness