Individual
MRS. CHARISSE MARIE CARUTH-IACONO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAADC
Contact information
Practice address
1625 SCHRADER BLVD, LOS ANGELES, CA 90028-6213
(213) 466-5042
Mailing address
1625 SCHRADER BLVD, LOS ANGELES, CA 90028-6213
(213) 466-5042
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS-21587
NC
390200000X
Student in an Organized Health Care Education/Training Program
RALR8960418
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01536011
MEDI-CAL
CA
Enumeration date
11/03/2015
Last updated
09/30/2020
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