Provider Demographics
NPI:1821642570
Name:STORAY-DEMBY, ANASA JAMALA (RAD-T)
Entity Type:Individual
Prefix:
First Name:ANASA
Middle Name:JAMALA
Last Name:STORAY-DEMBY
Suffix:
Gender:F
Credentials:RAD-T
Other - Prefix:MRS
Other - First Name:ANASA
Other - Middle Name:JAMALA
Other - Last Name:STORAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1650 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4958
Mailing Address - Country:US
Mailing Address - Phone:949-734-7432
Mailing Address - Fax:
Practice Address - Street 1:5025 E PACIFIC COAST HWY APT 240
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3297
Practice Address - Country:US
Practice Address - Phone:562-350-3512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC12166.101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional