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Organization
THE THERAPEUTIC DOJO PSYCHOTHERAPY SERVICES A PROFESSIONAL LICENSED CL
Active
Organization
THE THERAPEUTIC DOJO PSYCHOTHERAPY SERVICES A PROFESSIONAL LICENSED CL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANICIA TROTTER LCSW (DIRECTOR)
(949) 993-8604
Entity
Organization
Contact information
Practice address
1100 WILSHIRE BLVD APT 2210, LOS ANGELES, CA 90017-1951
(949) 993-8606
Mailing address
PO BOX 43, SAN DIMAS, CA 91773-0043
(949) 993-8606
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275612657
NPI
—
01
—
21067
CALIFORNIA BOARD OF BEHAVIORAL SCIENCES
CA
01
—
4765
STATE OF HAWAII DEPT. OF COMMERCE AND CONSUMER AFFAIRS
HI
Enumeration date
09/14/2022
Last updated
10/14/2022
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