Provider Demographics
NPI:1043561897
Name:HAMOUNI, NINA M (BA)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:M
Last Name:HAMOUNI
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 MIRA MAR AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-6729
Mailing Address - Country:US
Mailing Address - Phone:661-713-4907
Mailing Address - Fax:
Practice Address - Street 1:599 W 9TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3105
Practice Address - Country:US
Practice Address - Phone:310-831-0331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YAD400X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)