Provider Demographics
NPI:1902017478
Name:MORIN, MICHAEL LEE (CADC II)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEE
Last Name:MORIN
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 RIVERDALE DR
Mailing Address - Street 2:#22
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1546
Mailing Address - Country:US
Mailing Address - Phone:818-291-3370
Mailing Address - Fax:
Practice Address - Street 1:8604 LANKERSHIM BLVD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3140
Practice Address - Country:US
Practice Address - Phone:818-768-1640
Practice Address - Fax:818-768-1600
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128289101YP2500X
101YM0800X
CAA7460112101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health