Active NPI
Shakoya Green
- Mental Health Counselor
- Carson, CA
National Provider Identifier
1114355591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- ASW63261
- Practice address
- 335 E Albertoni St # 200-630
Carson, CA 90746-1425 - Phone
- (951) 238-0920
- NPI assigned
- Oct 23, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | ASW63261 | CA | Primary |
| Social Worker | 104100000X | |||
| Case Manager/Care Coordinator | 171M00000X |
Addresses
Primary practice location
335 E Albertoni St # 200-630
Carson, CA 90746-1425
Mailing address
335 E Albertoni St # 200-630
Carson, CA 90746-1425
Phone (951) 238-0920
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ASW63261 | CA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thomas House Temporary Shelter | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Voluntary or Charitable Agency
- Garden Grove, CA
- NPI 1740918846
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1382486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411084800000",
"number": "1114355591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "335 E ALBERTONI ST # 200-630",
"city": "CARSON",
"state": "CA",
"postal_code": "907461425",
"telephone_number": "951-238-0920"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "335 E ALBERTONI ST # 200-630",
"city": "CARSON",
"state": "CA",
"postal_code": "907461425",
"telephone_number": "951-238-0920"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "SHAKOYA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-10-23",
"last_updated": "2014-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "ASW63261",
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carson, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.