Healthcare Provider Details

I. General information

NPI: 1033703616
Provider Name (Legal Business Name): SHANTIE ABEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W 190TH ST STE 100B
GARDENA CA
90248-4320
US

IV. Provider business mailing address

PO BOX 72021
LOS ANGELES CA
90002-0021
US

V. Phone/Fax

Practice location:
  • Phone: 562-306-2925
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC18678
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: