MEDICARE: WANDERLUST WARRIORS COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1548150535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WANDERLUST WARRIORS COUNSELING

Provider Business Mailing Address
First Line	:	226 16TH AVE
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-1770
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	226 16TH AVE
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-1770
Country	:	US
Telephone Number	:	520-250-5999
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMY RAE JOHNSON
Credential	:	LCSW
Telephone Number	:	802-465-3737

Provider Enumeration Date	:	07/09/2025
Last Update Date	:	01/07/2026

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