Basic Information
| Provider Information | |||||||||
| NPI: | 1720114770 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUNCAN | ||||||||
| FirstName: | DAVE | ||||||||
| MiddleName: | RASHAWN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5031 CRENSHAW BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900431807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108685379 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5031 CRENSHAW BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900431807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108685379 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.