Provider Demographics
NPI:1871038224
Name:LOVETHREADS
Entity Type:Organization
Organization Name:LOVETHREADS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:310-632-8265
Mailing Address - Street 1:PO BOX 5102
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90749-5102
Mailing Address - Country:US
Mailing Address - Phone:310-701-1472
Mailing Address - Fax:310-632-8265
Practice Address - Street 1:12204 S SAN PEDRO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90061-2848
Practice Address - Country:US
Practice Address - Phone:310-701-1472
Practice Address - Fax:310-632-8265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty