Provider Demographics
NPI:1720879430
Name:LOTT, KEVIN B (CADC III)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:B
Last Name:LOTT
Suffix:
Gender:M
Credentials:CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5410 QUAKERTOWN AVE APT 217
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2527
Mailing Address - Country:US
Mailing Address - Phone:818-587-6422
Mailing Address - Fax:
Practice Address - Street 1:22122 SHERMAN WAY STE 105
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1159
Practice Address - Country:US
Practice Address - Phone:818-912-6412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB00003320324101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)