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Organization
IM POSSIBLE YOUTH FOUNDATION
Active
Organization
IM POSSIBLE YOUTH FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MILLICENT SHUNGU MAZAUWABA M.A. (CHEIF EXECUTIVE OFFICER)
(310) 677-7080
Entity
Organization
Contact information
Practice address
11011 CRENSHAW BLVD, SUITE 203, INGLEWOOD, CA 90303-6330
(310) 677-7080
(866) 894-5431
Mailing address
11011 CRENSHAW BLVD, SUITE 203, INGLEWOOD, CA 90303-6330
(310) 677-7080
(866) 894-5431
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
NULL
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
Primary
—
NULL
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
01/03/2013
Last updated
01/03/2013
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