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400 Continental Blvd Fl 6 El Segundo CA 90245-5074 | |
| (310) 648-0700 | |
| (310) 554-5662 |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 400 Continental Blvd Fl 6, El Segundo, California |
| Authorized Official Name and Position | Margena Lorine Carter (OWNER) |
| Authorized Official Contact | 3106480700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
400 Continental Blvd Fl 6 El Segundo CA 90245-5074 Ph: (310) 648-0700 | 400 Continental Blvd Fl 6 El Segundo CA 90245-5074 Ph: (310) 648-0700 |
| NPI Number | 1558889964 |
|---|---|
| Provider Enumeration Date | 09/06/2017 |
| Last Update Date | 01/08/2024 |
| Certification Date | 01/08/2024 |
| Medicare PECOS PAC ID | 6608219464 |
|---|---|
| Medicare Enrollment ID | O20240208001673 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558889964 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 106H00000X | Marriage & Family Therapist | 93514 (California) | Primary |
| Provider Name | Margena Lorine Carter |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1023379484 PECOS PAC ID: 1658725619 Enrollment ID: I20240208001845 |
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