Provider Demographics
NPI:1336847912
Name:DOSTA, JOHN CHARLES (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:DOSTA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5541 SERENE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4832
Mailing Address - Country:US
Mailing Address - Phone:562-234-0097
Mailing Address - Fax:
Practice Address - Street 1:5541 SERENE DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-4832
Practice Address - Country:US
Practice Address - Phone:562-234-0097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1105411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical