Provider Demographics
NPI:1689187288
Name:VIP COMMUNITY MENTAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:VIP COMMUNITY MENTAL HEALTH CENTER, INC.
Other - Org Name:VIP WOODROW WILSON SENIOR HIGH SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHIADA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:323-221-4134
Mailing Address - Street 1:1721 GRIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-3312
Mailing Address - Country:US
Mailing Address - Phone:323-221-4134
Mailing Address - Fax:
Practice Address - Street 1:4500 MULTNOMAH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-3703
Practice Address - Country:US
Practice Address - Phone:323-221-4134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIP COMMUNITY MENTAL HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health