Healthcare Provider Details

I. General information

NPI: 1316557036
Provider Name (Legal Business Name): JANISE L CARMICHAEL LPCC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANISE L CARMICHAEL LMHC

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E CARSON PLAZA DR STE 224
CARSON CA
90746-7337
US

IV. Provider business mailing address

102 MEDORA PL
SYRACUSE NY
13207-2226
US

V. Phone/Fax

Practice location:
  • Phone: 213-793-4059
  • Fax:
Mailing address:
  • Phone: 315-565-9894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16275
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number016666
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: