Provider Demographics
NPI:1821464462
Name:HUANG, LISHI LEO (SUPPORT SPECIALIST)
Entity Type:Individual
Prefix:
First Name:LISHI
Middle Name:LEO
Last Name:HUANG
Suffix:
Gender:M
Credentials:SUPPORT SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-1237
Mailing Address - Country:US
Mailing Address - Phone:213-493-4664
Mailing Address - Fax:
Practice Address - Street 1:2116 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-1237
Practice Address - Country:US
Practice Address - Phone:213-493-4664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
CA1910559101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker