Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

11821 Foothill Blvd

Organization Addiction (Substance Use Disorder) Counselor · NPI 1164767356

11821 Foothill Blvd is an Addiction (Substance Use Disorder) Counselor in Los Angeles, California. Registered with an NPI since 2012.

In the registry since
2012

Practice location Address checks out

5436 S Broadway
Los Angeles, CA 90037
Phone: (818) 694-7206
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Addiction (Substance Use Disorder) Counselor (primary) Taxonomy 101YA0400X

Record details

NPI number1164767356
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Derrick Fortune — Counselor · (818) 694-7206
NPI enumeratedNovember 29, 2012
Last updated in NPPESNovember 29, 2012
Mailing address11821 Foothill Blvd # K35, Lake View Terrace, CA 91342-7200

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