Organization
LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH
Active
Parent organization
-
Other names
AFH - MLK Haven Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
-
Authorized official
LISA H. WONG PSY.D. (ACTING DIRECTOR)
(213) 738-4601
Entity
Organization
Contact information
Practice address
12021 WILMINGTON AVE, LOS ANGELES, CA 90059
(424) 338-2801
(310) 223-0319
Mailing address
510 S VERMONT AVE, LOS ANGELES, CA 90020-1992
(213) 738-4601
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6864B
—
CA
Enumeration date
02/14/2017
Last updated
09/01/2022
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