| The Therapeutic Dojo Psychotherapy Services A Professional Licensed Cl | |
|
1100 Wilshire Blvd Apt 2210 Los Angeles CA 90017-1951 | |
| (949) 993-8606 | |
| Not Available |
| Full Name | The Therapeutic Dojo Psychotherapy Services A Professional Licensed Cl |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1100 Wilshire Blvd Apt 2210, Los Angeles, California |
| Authorized Official Name and Position | Tanicia Trotter (DIRECTOR) |
| Authorized Official Contact | 9499938604 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Therapeutic Dojo Psychotherapy Services A Professional Licensed Cl Po Box 43 San Dimas CA 91773-0043 Ph: (949) 993-8606 | The Therapeutic Dojo Psychotherapy Services A Professional Licensed Cl 1100 Wilshire Blvd Apt 2210 Los Angeles CA 90017-1951 Ph: (949) 993-8606 |
| NPI Number | 1336861517 |
|---|---|
| Provider Enumeration Date | 09/14/2022 |
| Last Update Date | 10/14/2022 |
| Certification Date | 10/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336861517 | NPI | - | NPPES |
| 4765 | Other | HI | STATE OF HAWAII DEPT. OF COMMERCE AND CONSUMER AFFAIRS |
| 21067 | Other | CA | CALIFORNIA BOARD OF BEHAVIORAL SCIENCES |
| 1275612657 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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