Basic Information
| Provider Information | |||||||||
| NPI: | 1124520606 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NARCISSE | ||||||||
| FirstName: | MEREDITH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3709 RUTHELEN STREET | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232468920 | ||||||||
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| Practice Location | |||||||||
| Address1: | AEGIS TREATMENT CENTER 14240 IMPERIAL HWY | ||||||||
| Address2: | |||||||||
| City: | LA MIRIDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629461587 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2018 | ||||||||
| LastUpdateDate: | 04/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.