Active NPI
Antawny Jefferson, CERTIFIED COUNSELOR
- Addiction (Substance Use Disorder) Counselor
- Los Angeles, CA
National Provider Identifier
1851958045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 17924
- Practice address
- 12021 Wilmington Ave
Los Angeles, CA 90059-3019 - Phone
- (424) 454-6041
- NPI assigned
- May 22, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 17924 | CA | Primary |
Addresses
Primary practice location
12021 Wilmington Ave
Los Angeles, CA 90059-3019
Mailing address
1563 Mission St
San Francisco, CA 94103-2543
Phone (415) 762-3700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17924 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759449600000",
"number": "1851958045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1563 MISSION ST",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941032543",
"telephone_number": "415-762-3700",
"fax_number": "415-865-0119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12021 WILMINGTON AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900593019",
"telephone_number": "424-454-6041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEFFERSON",
"first_name": "ANTAWNY",
"credential": "CERTIFIED COUNSELOR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-22",
"last_updated": "2025-10-03",
"certification_date": "2025-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "17924",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.