Healthcare Provider Details

I. General information

NPI: 1679357107
Provider Name (Legal Business Name): WILLING 2 MOVE FORWARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5543 ATLANTIC AVE STE B
LONG BEACH CA
90805-5412
US

IV. Provider business mailing address

1104 OLIVE AVE
LONG BEACH CA
90813-3521
US

V. Phone/Fax

Practice location:
  • Phone: 562-612-1524
  • Fax:
Mailing address:
  • Phone: 562-528-2139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. MICHELLE ANNE TALBOTT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 562-528-2139