Nichelle Space
Marriage & Family Therapist in Los Angeles, CA. Individual provider (NPI-1).
NPI number1013441211
StatusActive
Last updated in NPPESFeb 10, 2020
Details
- NPI
- 1013441211
- Entity type
- Individual (NPI-1)
- Name
- Nichelle Space
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Apr 13, 2017
- Certification date
- Feb 10, 2020
- Last updated
- Feb 10, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | – | – | Yes |
| 101YM0800X | Counselor, Mental Health | – | – | |
| 225XM0800X | Occupational Therapist, Mental Health | – | – |
Practice location
8019 Compton AveLos Angeles, CA 90001-3409
Phone 323-586-7333
Mailing address
8019 Compton AveLos Angeles, CA 90001-3409
Phone 323-586-7333
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