Healthcare Provider Details

I. General information

NPI: 1245950484
Provider Name (Legal Business Name): ANGEL FACEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 07/26/2024
Certification Date: 06/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 HAWTHORNE BLVD
REDONDO BEACH CA
90278-3923
US

IV. Provider business mailing address

2510 MONTEREY ST
TORRANCE CA
90503-7238
US

V. Phone/Fax

Practice location:
  • Phone: 310-565-7037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW76305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: