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General NPI Number Information
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NPI Number | 1366006645
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Entity Type | Organization
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Legal Business Name | CAROL A. POLEVOI, LMFT/WELLNESS COACH, APC
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 04/23/2019
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Provider Practice Location Address
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Address Line | 16055 VENTURA BLVD STE 717
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City | ENCINO
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State | CA
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Zip | 91436-2610
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Country | US
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Telephone | 818-889-3905
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Fax |
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Provider Business Mailing Address
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Address Line | 4930 BALBOA BLVD UNIT 260734
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City | ENCINO
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State | CA
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Zip | 91426-7037
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Country | US
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Telephone | 818-889-3905
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CAROL ANN POLEVOI
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Credential | LMFT
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Telephone | 818-889-3905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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