Provider Demographics
NPI:1760749279
Name:VAN, SOPANI (AOD COUNSELCERTIFIED)
Entity Type:Individual
Prefix:
First Name:SOPANI
Middle Name:
Last Name:VAN
Suffix:
Gender:F
Credentials:AOD COUNSELCERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 CENTURY PARK E STE 1210
Mailing Address - Street 2:
Mailing Address - City:CENTURY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2015
Mailing Address - Country:US
Mailing Address - Phone:310-553-9500
Mailing Address - Fax:310-553-9500
Practice Address - Street 1:2080 CENTURY PARK E STE 1210
Practice Address - Street 2:
Practice Address - City:CENTURY CITY
Practice Address - State:CA
Practice Address - Zip Code:90067-2015
Practice Address - Country:US
Practice Address - Phone:310-553-9500
Practice Address - Fax:310-553-9500
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor