Individual
BERVICK DECULUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3210 W JEFFERSON BLVD, LOS ANGELES, CA 90018-3230
(323) 731-4981
(323) 731-4958
Mailing address
3210 W JEFFERSON BLVD, LOS ANGELES, CA 90018-3230
(323) 731-4981
(323) 731-4958
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
12/01/2010
Last updated
12/01/2010
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