Provider Demographics
NPI:1710459359
Name:IBRAHIM, DAVID (LMFT, CADC II)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:LMFT, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N BRAND BLVD STE 412
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2614
Mailing Address - Country:US
Mailing Address - Phone:323-533-8805
Mailing Address - Fax:
Practice Address - Street 1:100 N BRAND BLVD STE 412
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2614
Practice Address - Country:US
Practice Address - Phone:323-533-8805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII055350418101YA0400X
CA120556106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)