Provider Demographics
NPI:1760269773
Name:KING-CANTWAY, JAMES ALLEN (SUDRC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALLEN
Last Name:KING-CANTWAY
Suffix:
Gender:M
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 SUMMITRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-1607
Mailing Address - Country:US
Mailing Address - Phone:424-249-3849
Mailing Address - Fax:
Practice Address - Street 1:1775 SUMMITRIDGE DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-1607
Practice Address - Country:US
Practice Address - Phone:424-249-3849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15922101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)