Organization
NIA FOUNDATION
Active
Organization
NIA FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE H. DAVIS (ACCOUNTING COORDINATOR)
(626) 676-9664
Entity
Organization
Contact information
Practice address
5830 OVERHILL DR STE 2, LOS ANGELES, CA 90043-2710
(213) 424-2497
Mailing address
5361 OVERDALE DR, LOS ANGELES, CA 90043-2022
(562) 480-7251
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
—
—
Other
Enumeration date
09/09/2024
Last updated
09/09/2024
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