Provider Demographics
NPI:1366006645
Name:CAROL A. POLEVOI, LMFT/WELLNESS COACH, APC
Entity Type:Organization
Organization Name:CAROL A. POLEVOI, LMFT/WELLNESS COACH, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:POLEVOI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:818-889-3905
Mailing Address - Street 1:4930 BALBOA BLVD UNIT 260734
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426-7037
Mailing Address - Country:US
Mailing Address - Phone:818-889-3905
Mailing Address - Fax:
Practice Address - Street 1:16055 VENTURA BLVD STE 717
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2610
Practice Address - Country:US
Practice Address - Phone:818-889-3905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty