Healthcare Provider Details

I. General information

NPI: 1548185002
Provider Name (Legal Business Name): YAKEMA LASHAY IVY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 W 135TH ST
GARDENA CA
90247-1907
US

IV. Provider business mailing address

1202 W 135TH ST
GARDENA CA
90247-1907
US

V. Phone/Fax

Practice location:
  • Phone: 323-537-5908
  • Fax:
Mailing address:
  • Phone: 323-537-5908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number32903040382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: