Individual
AVERY WORTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
503 OCEAN FRONT WALK, VENICE, CA 90291-2403
(310) 392-3070
Mailing address
3114 W 74TH ST, LOS ANGELES, CA 90043-5008
(323) 841-9944
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
03/11/2024
Last updated
03/11/2024
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