Provider Demographics
NPI:1497075311
Name:JUNIOUS, SHAQUITA RAQUEL
Entity Type:Individual
Prefix:
First Name:SHAQUITA
Middle Name:RAQUEL
Last Name:JUNIOUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:
Other - Last Name:JUNIOUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT,APPC
Mailing Address - Street 1:5715 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-4131
Mailing Address - Country:US
Mailing Address - Phone:323-948-0444
Mailing Address - Fax:323-948-0443
Practice Address - Street 1:5715 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037
Practice Address - Country:US
Practice Address - Phone:323-948-0444
Practice Address - Fax:323-948-0443
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA1169101YP2500X
CA106890106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional