Provider Demographics
NPI:1619248564
Name:FRANKS, CONNIE
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:
Last Name:FRANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 S EASTERN AVE
Mailing Address - Street 2:142
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-4017
Mailing Address - Country:US
Mailing Address - Phone:323-278-6501
Mailing Address - Fax:
Practice Address - Street 1:5900 S EASTERN AVE
Practice Address - Street 2:142
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-4017
Practice Address - Country:US
Practice Address - Phone:323-278-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7429Medicaid