Healthcare Provider Details

I. General information

NPI: 1003761966
Provider Name (Legal Business Name): HEALING MINDS MARRIAGE AND FAMILY THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 E CARSON PLAZA DR STE 217
CARSON CA
90746-3274
US

IV. Provider business mailing address

444 W OCEAN BLVD STE 800
LONG BEACH CA
90802-4529
US

V. Phone/Fax

Practice location:
  • Phone: 562-729-5803
  • Fax:
Mailing address:
  • Phone: 562-729-5803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: KHADEJAH ABRAHAM
Title or Position: LMFT
Credential:
Phone: 562-729-5803