Organization
AIRPORT MARINA COUNSELING SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDEN GARCIA-BALIS LMFT (EXECTUTIVE DIRECTOR)
(310) 670-1410
Entity
Organization
Contact information
Practice address
7891 LA TIJERA BLVD, NONE, LOS ANGELES, CA 90045-3145
(310) 670-1410
(310) 670-0919
Mailing address
7891 LA TIJERA BLVD, NONE, LOS ANGELES, CA 90045-3145
(310) 670-1410
(310) 670-0919
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
960000174
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
960000174
STATE OF CALIFORNIA DEPARTMENT OF PUBLIC HEALTH
CA
Enumeration date
02/04/2016
Last updated
02/04/2016
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