Active NPI
Reggie Mitchell, CADC 2-CA
- Addiction (Substance Use Disorder) Counselor
- Gardena, CA
National Provider Identifier
1669695862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- AII3551214
- Practice address
- 15519 Crenshaw Blvd
Gardena, CA 90249-4525 - Phone
- (310) 679-9031
- NPI assigned
- Apr 10, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Counselor | 225C00000X | |||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | AII3551214 | CA | Primary |
Addresses
Primary practice location
15519 Crenshaw Blvd
Gardena, CA 90249-4525
Mailing address
202 W. 71St Street
Los Angeles, CA 90003
Phone (323) 283-5805
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 |
|---|---|---|---|
| AII3551214 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576627200000",
"number": "1669695862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 W. 71ST STREET",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90003",
"telephone_number": "323-283-5805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15519 CRENSHAW BLVD",
"city": "GARDENA",
"state": "CA",
"postal_code": "902494525",
"telephone_number": "310-679-9031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "REGGIE",
"credential": "CADC 2-CA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-10",
"last_updated": "2019-12-18",
"certification_date": "2019-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "225C00000X",
"taxonomy_group": "",
"desc": "Rehabilitation Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "AII3551214",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gardena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.