Healthcare Provider Details

I. General information

NPI: 1235904384
Provider Name (Legal Business Name): WYNNING FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 E PACIFIC COAST HWY STE 200
LONG BEACH CA
90804-3399
US

IV. Provider business mailing address

34830 FONTANA DR
STERLING HEIGHTS MI
48312-5732
US

V. Phone/Fax

Practice location:
  • Phone: 313-212-7774
  • Fax:
Mailing address:
  • Phone: 313-212-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: WYNN ANTHONY SARDEN
Title or Position: FOUNDER/PRESIDENT
Credential:
Phone: 313-212-7774