Provider Demographics
NPI:1992282834
Name:COMMUNITY FAMILY GUIDANCE CENTER
Entity type:Organization
Organization Name:COMMUNITY FAMILY GUIDANCE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF QA
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:562-924-5526
Mailing Address - Street 1:10929 SOUTH ST STE 208B
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-5368
Mailing Address - Country:US
Mailing Address - Phone:529-924-5526
Mailing Address - Fax:562-924-1050
Practice Address - Street 1:5140 FLORENCE AVE STE F
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-3887
Practice Address - Country:US
Practice Address - Phone:562-924-5526
Practice Address - Fax:562-924-1050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY FAMILY GUIDANCE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-24
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14662251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health