Provider Demographics
NPI:1992101778
Name:SOUTHERN CALIFORNIA DRUG DIVERSION
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA DRUG DIVERSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LYTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:310-951-2748
Mailing Address - Street 1:2370 W CARSON ST
Mailing Address - Street 2:235
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3100
Mailing Address - Country:US
Mailing Address - Phone:310-951-2748
Mailing Address - Fax:
Practice Address - Street 1:2370 W CARSON ST
Practice Address - Street 2:235
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3100
Practice Address - Country:US
Practice Address - Phone:310-951-2748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health