South Bay Connect Treatment Center

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

21303 Issued in CA

Legal business name

SOUTH BAY CONNECT TREATMENT CENTER

Practice address

916 N Western Ave Ste 210
San Pedro, CA 90732-2407

Phone

(310) 776-7406

NPI assigned

Oct 10, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Alicia Ann Macgowan, LCSW

Title

Founder

Phone

(310) 776-7406

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1346790730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "916 N WESTERN AVE",
            "address_2": "SUITE 210",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907322435",
            "telephone_number": "310-776-7406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 N WESTERN AVE STE 210",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907322407",
            "telephone_number": "310-776-7406"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "916 N Western Ave Ste 210",
            "address_purpose": "LOCATION",
            "city": "San Pedro",
            "state": "CA",
            "postal_code": "907322407",
            "country_code": "US",
            "telephone_number": "310-776-7406",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTH BAY CONNECT TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-10",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MACGOWAN",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "310-776-7406",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "21303",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1619157716",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.