Healthcare Provider Details

I. General information

NPI: 1851071609
Provider Name (Legal Business Name): THE WAVE WITHIN PROFESSIONAL CLINICAL COUNSELOR CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 05/14/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2447 SANTA CLARA AVE STE 301
ALAMEDA CA
94501-4579
US

IV. Provider business mailing address

2447 SANTA CLARA AVE STE 301
ALAMEDA CA
94501-4579
US

V. Phone/Fax

Practice location:
  • Phone: 510-239-7022
  • Fax:
Mailing address:
  • Phone: 510-239-7022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANNIE SHIRRELL
Title or Position: CEO
Credential: LMFT, LPCC
Phone: 510-239-7022