Provider Demographics
NPI:1376891630
Name:SISTAHPEACE RESHAPING WELLBALANCE CC SERVICES
Entity Type:Organization
Organization Name:SISTAHPEACE RESHAPING WELLBALANCE CC SERVICES
Other - Org Name:SRWCCS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/CLINICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:A.
Authorized Official - Middle Name:
Authorized Official - Last Name:ASUNGI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:562-498-3318
Mailing Address - Street 1:3939 ATLANTIC AVE
Mailing Address - Street 2:# 208
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3536
Mailing Address - Country:US
Mailing Address - Phone:562-498-3318
Mailing Address - Fax:
Practice Address - Street 1:3939 ATLANTIC AVE
Practice Address - Street 2:# 208
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3536
Practice Address - Country:US
Practice Address - Phone:562-498-3318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 27091101YA0400X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty