Provider Demographics
NPI:1639994361
Name:RADIATE HOPE LICENSED PROFESSIONAL CLINICAL COUNSELOR, PC
Entity type:Organization
Organization Name:RADIATE HOPE LICENSED PROFESSIONAL CLINICAL COUNSELOR, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:909-501-4688
Mailing Address - Street 1:12600 BRADDOCK DR APT 118
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-6740
Mailing Address - Country:US
Mailing Address - Phone:909-501-4688
Mailing Address - Fax:
Practice Address - Street 1:12600 BRADDOCK DR APT 118
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-6740
Practice Address - Country:US
Practice Address - Phone:909-501-4688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty