Provider Demographics
NPI:1821306309
Name:PROVIDENCE COMMUNITY SERVICES
Entity Type:Organization
Organization Name:PROVIDENCE COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH INTERN
Authorized Official - Prefix:
Authorized Official - First Name:NIKITA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:OKUONGHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-396-8153
Mailing Address - Street 1:4918 ABBOTT RD
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2355
Mailing Address - Country:US
Mailing Address - Phone:562-396-8153
Mailing Address - Fax:
Practice Address - Street 1:4281 KATELLA AVE STE 201
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6509
Practice Address - Country:US
Practice Address - Phone:562-467-5440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-19
Last Update Date:2010-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty