Provider Demographics
NPI:1861840241
Name:DEVITT, TIMOTHY (CADC 1)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:DEVITT
Suffix:
Gender:M
Credentials:CADC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7941 1/2 BLACKBURN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4417
Mailing Address - Country:US
Mailing Address - Phone:310-625-6776
Mailing Address - Fax:
Practice Address - Street 1:7941 1/2 BLACKBURN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4417
Practice Address - Country:US
Practice Address - Phone:310-625-6776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)