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Organization
COMMUNITY EVOLUTION ACQUISITION
Active
Organization
COMMUNITY EVOLUTION ACQUISITION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIA LOPEZ BACHELORS SOCIAL W (CEO)
(424) 210-2933
Entity
Organization
Contact information
Practice address
1767 VALLECITO DR, SAN PEDRO, CA 90732-4245
(424) 503-3336
Mailing address
1767 VALLECITO DR, SAN PEDRO, CA 90732-4245
(424) 210-2933
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
251B00000X
Case Management Agency
—
NULL
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251G00000X
Community Based Hospice Care Agency
—
NULL
261Q00000X
Clinic/Center
—
NULL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
385H00000X
Respite Care
Primary
—
NULL
Other
Enumeration date
12/02/2025
Last updated
09/19/2026
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