Provider Demographics
NPI:1881356780
Name:LONDON, MANDI KAY (RADT)
Entity type:Individual
Prefix:
First Name:MANDI
Middle Name:KAY
Last Name:LONDON
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43434 32ND ST W APT 104
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-5470
Mailing Address - Country:US
Mailing Address - Phone:619-900-8905
Mailing Address - Fax:
Practice Address - Street 1:1331 W AVENUE J STE 206
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2954
Practice Address - Country:US
Practice Address - Phone:661-802-7167
Practice Address - Fax:661-802-4961
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)