Provider Demographics
NPI:1568038974
Name:POLLATOS, KITSA KIKI (LCSW 24983)
Entity Type:Individual
Prefix:
First Name:KITSA
Middle Name:KIKI
Last Name:POLLATOS
Suffix:
Gender:F
Credentials:LCSW 24983
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323A E PALMDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4957
Mailing Address - Country:US
Mailing Address - Phone:562-335-2210
Mailing Address - Fax:
Practice Address - Street 1:39959 SIERRA HWY STE 150
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-3320
Practice Address - Country:US
Practice Address - Phone:562-335-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA249831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical