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General NPI Number Information
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NPI Number | 1376891630
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Entity Type | Organization
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Legal Business Name | SISTAHPEACE RESHAPING WELLBALANCE CC SERVICES
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 08/17/2012
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Provider Practice Location Address
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Address Line | 3939 ATLANTIC AVE # 208
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City | LONG BEACH
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State | CA
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Zip | 90807-3536
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Country | US
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Telephone | 562-498-3318
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Fax |
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Provider Business Mailing Address
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Address Line | 3939 ATLANTIC AVE # 208
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City | LONG BEACH
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State | CA
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Zip | 90807-3536
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Country | US
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Telephone | 562-498-3318
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL THERAPIST
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Name | MS. A. ASUNGI
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Credential | L.C.S.W.
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Telephone | 562-498-3318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCS 27091
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LCS 27091
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 27091
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License Number State | CA
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