Provider Demographics
NPI:1508207887
Name:ALLISON PERKS LICENSED CLINICAL SOCIAL WORKER INCORPORATED
Entity Type:Organization
Organization Name:ALLISON PERKS LICENSED CLINICAL SOCIAL WORKER INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PERKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:310-829-0655
Mailing Address - Street 1:6362 COLGATE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4407
Mailing Address - Country:US
Mailing Address - Phone:310-729-0655
Mailing Address - Fax:310-919-3515
Practice Address - Street 1:6362 COLGATE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4407
Practice Address - Country:US
Practice Address - Phone:310-729-0655
Practice Address - Fax:310-919-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 20844251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health