Healthcare Provider Details

I. General information

NPI: 1306777479
Provider Name (Legal Business Name): HEALING SUPPORT THERAPY, LICENSED CLINICAL SOCIAL WORKER CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 ATLANTIC AVE # 227
LONG BEACH CA
90807-3536
US

IV. Provider business mailing address

3939 ATLANTIC AVE # 227
LONG BEACH CA
90807-3536
US

V. Phone/Fax

Practice location:
  • Phone: 562-567-6772
  • Fax:
Mailing address:
  • Phone: 562-567-6772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: YESENIA VENTURA
Title or Position: CEO
Credential: LCSW
Phone: 323-983-3699