Provider Demographics
NPI:1508341421
Name:ACOSTA, LELA LYNN (CADTP ADVANCE)
Entity Type:Individual
Prefix:
First Name:LELA
Middle Name:LYNN
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:CADTP ADVANCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15067 LEFFINGWELL RD APT 12
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-2142
Mailing Address - Country:US
Mailing Address - Phone:562-668-0151
Mailing Address - Fax:
Practice Address - Street 1:16314 CORNUTA AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-4814
Practice Address - Country:US
Practice Address - Phone:562-461-9272
Practice Address - Fax:562-461-9282
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)