Provider Demographics
NPI:1053559773
Name:PERRY, TAWANA LYNETTE
Entity type:Individual
Prefix:MRS
First Name:TAWANA
Middle Name:LYNETTE
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 STOCKER ST
Mailing Address - Street 2:401
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-5108
Mailing Address - Country:US
Mailing Address - Phone:323-299-4000
Mailing Address - Fax:323-299-4004
Practice Address - Street 1:3701 STOCKER ST
Practice Address - Street 2:401
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-5108
Practice Address - Country:US
Practice Address - Phone:323-299-4000
Practice Address - Fax:323-299-4004
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)