Provider Demographics
NPI:1306593405
Name:TRINITY, YANCY (RADT)
Entity type:Individual
Prefix:MR
First Name:YANCY
Middle Name:
Last Name:TRINITY
Suffix:
Gender:M
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:CA
Mailing Address - Zip Code:92325-0130
Mailing Address - Country:US
Mailing Address - Phone:818-397-6681
Mailing Address - Fax:
Practice Address - Street 1:2542 E FLORENCE AVE STE H
Practice Address - Street 2:
Practice Address - City:WALNUT PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4774
Practice Address - Country:US
Practice Address - Phone:323-372-1281
Practice Address - Fax:323-372-1282
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)