Provider Demographics
NPI:1619700267
Name:JOANITIS, MICHAEL CHRISTOPHER (APCC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHRISTOPHER
Last Name:JOANITIS
Suffix:
Gender:M
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 S MIRALESTE DR UNIT 387
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-6096
Mailing Address - Country:US
Mailing Address - Phone:805-284-6224
Mailing Address - Fax:
Practice Address - Street 1:3812 SEPULVEDA BLVD STE 260
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2457
Practice Address - Country:US
Practice Address - Phone:661-535-0916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15985101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health