Provider Demographics
NPI:1477809291
Name:NATIONAL COUNCIL ON ALCOHOLISM & DRUG DEPENDENCE OF THE SAN FERNANDO V
Entity Type:Organization
Organization Name:NATIONAL COUNCIL ON ALCOHOLISM & DRUG DEPENDENCE OF THE SAN FERNANDO V
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:DORRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:818-216-4183
Mailing Address - Street 1:6166 VESPER AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2851
Mailing Address - Country:US
Mailing Address - Phone:818-997-1414
Mailing Address - Fax:818-997-0851
Practice Address - Street 1:6166 VESPER AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2851
Practice Address - Country:US
Practice Address - Phone:818-997-1414
Practice Address - Fax:818-997-0851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190049AN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health