Provider Demographics
NPI:1174655799
Name:JAMES, COLETTE DION (BA)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:DION
Last Name:JAMES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 E 120TH ST
Mailing Address - Street 2:TRAILER #6
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-3051
Mailing Address - Country:US
Mailing Address - Phone:310-668-8311
Mailing Address - Fax:310-668-3458
Practice Address - Street 1:1721 E 120TH ST
Practice Address - Street 2:TRAILER #6
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-3051
Practice Address - Country:US
Practice Address - Phone:310-668-8311
Practice Address - Fax:310-668-3458
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF59399106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist