Healthcare Provider Details

I. General information

NPI: 1396533527
Provider Name (Legal Business Name): SALECIA FAYE MEKANISI M.ED. , PPS, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 D ST
ANTIOCH CA
94509-2346
US

IV. Provider business mailing address

3350 E 7TH ST # 246
LONG BEACH CA
90804-5003
US

V. Phone/Fax

Practice location:
  • Phone: 925-779-7400
  • Fax:
Mailing address:
  • Phone: 714-616-2532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number230009351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: