Provider Demographics
NPI:1831631266
Name:DUBIN, ALIZA (MA, CPC)
Entity type:Individual
Prefix:
First Name:ALIZA
Middle Name:
Last Name:DUBIN
Suffix:
Gender:F
Credentials:MA, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11314 DELANO ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4222
Mailing Address - Country:US
Mailing Address - Phone:818-635-4344
Mailing Address - Fax:
Practice Address - Street 1:11314 DELANO ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-4222
Practice Address - Country:US
Practice Address - Phone:818-635-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31861101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health