Provider Demographics
NPI:1033796669
Name:CITY2VILLAGE INTERNATIONAL INITIATIVE
Entity Type:Organization
Organization Name:CITY2VILLAGE INTERNATIONAL INITIATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NYIEMA
Authorized Official - Middle Name:DESIREE'
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-738-9271
Mailing Address - Street 1:335 E ALBERTONI ST STE 200-722
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-1425
Mailing Address - Country:US
Mailing Address - Phone:310-738-9271
Mailing Address - Fax:844-850-5892
Practice Address - Street 1:18726 S WESTERN AVE STE 403
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3858
Practice Address - Country:US
Practice Address - Phone:310-769-5710
Practice Address - Fax:844-850-5892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty