Basic Information
| Provider Information | |||||||||
| NPI: | 1639570138 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOLSON | ||||||||
| FirstName: | DIA | ||||||||
| MiddleName: | SARON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5849 CROCKER STREET | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232344445 | ||||||||
| FaxNumber: | 3232344477 | ||||||||
| Practice Location | |||||||||
| Address1: | 5849 CROCKER STREET | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232344445 | ||||||||
| FaxNumber: | 3232344477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2014 | ||||||||
| LastUpdateDate: | 09/16/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.