Provider Demographics
NPI:1124789268
Name:DEVELOP ACHIEVE SUCCEED
Entity type:Organization
Organization Name:DEVELOP ACHIEVE SUCCEED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIVINITY
Authorized Official - Middle Name:
Authorized Official - Last Name:SARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:562-965-6782
Mailing Address - Street 1:9835 FLOWER ST UNIT 1523
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90707-7074
Mailing Address - Country:US
Mailing Address - Phone:562-965-6782
Mailing Address - Fax:
Practice Address - Street 1:1225 W 190TH ST # 455G
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4320
Practice Address - Country:US
Practice Address - Phone:562-965-6782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)