| Act5 Community Liaison Corp | |
|
955 Deep Valley Dr Ste 2411 Palos Verdes Pen CA 90274 | |
| (424) 262-7775 | |
| Not Available |
| Full Name | Act5 Community Liaison Corp |
|---|---|
| Speciality | Psychologist |
| Location | 955 Deep Valley Dr, Palos Verdes Pen, California |
| Authorized Official Name and Position | Kalina Noelle (PSYCHOLOGIST) |
| Authorized Official Contact | 4242627775 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Act5 Community Liaison Corp 955 Deep Valley Dr Ste 2411 Palos Verdes Pen CA 90274 Ph: (424) 262-7775 | Act5 Community Liaison Corp 955 Deep Valley Dr Ste 2411 Palos Verdes Pen CA 90274 Ph: (424) 262-7775 |
| NPI Number | 1568222776 |
|---|---|
| Provider Enumeration Date | 03/22/2024 |
| Last Update Date | 04/06/2024 |
| Certification Date | 04/06/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568222776 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| 103TC2200X | Psychologist - Clinical Child & Adolescent | (* (Not Available)) | Secondary |
Blue Coast Healing Arts Spc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 955 Deep Valley Dr, 2411, Palos Verdes Pen, CA 90274 Phone: 424-262-8388 |