OrganizationActive
11821 Foothill Blvd
NPI 1164767356 · Addiction (Substance Use Disorder) Counselor · Los Angeles, CA
Provider details
- NPI number
- 1164767356
- Entity type
- Organization
- Primary specialty
- Addiction (Substance Use Disorder) CounselorBehavioral Health & Social Service Providers
- Authorized official
- Derrick Fortune, Counselor
Mailing address
11821 Foothill Blvd # K35
Lake View Terrace, CA 91342-7200
Registry dates
- Enumerated
- 2012-11-29
- Last updated
- 2012-11-29
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.