Organization
LEGACY VALLEY ADDICTION TREATMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA L ABBOTT LMFT (CHIEF EXECUTIVE OFFICER)
(760) 912-5553
Entity
Organization
Contact information
Practice address
16519 VICTOR ST STE 302, VICTORVILLE, CA 92395-3967
(760) 305-9677
Mailing address
12654 SEVENTH AVE, VICTORVILLE, CA 92395-9577
(760) 912-5553
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
03/05/2025
Last updated
03/05/2025
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