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General NPI Number Information
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NPI Number | 1033796669
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Entity Type | Organization
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Legal Business Name | CITY2VILLAGE INTERNATIONAL INITIATIVE
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Dates
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Enumeration Date | 03/28/2021
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Last Update Date | 03/28/2021
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Provider Practice Location Address
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Address Line | 18726 S WESTERN AVE STE 403
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City | GARDENA
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State | CA
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Zip | 90248-3858
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Country | US
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Telephone | 310-769-5710
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Fax | 844-850-5892
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Provider Business Mailing Address
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Address Line | 335 E ALBERTONI ST STE 200-722
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City | CARSON
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State | CA
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Zip | 90746-1425
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Country | US
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Telephone | 310-738-9271
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Fax | 844-850-5892
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. NYIEMA DESIREE' CARTER
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Credential | PSYD
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Telephone | 310-738-9271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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