Healthcare Provider Details

I. General information

NPI: 1568289106
Provider Name (Legal Business Name): BLACK UNICORN WELLNESS SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 HEACOCK ST STE C238
MORENO VALLEY CA
92553-6268
US

IV. Provider business mailing address

30141 ANTELOPE RD # D-666
MENIFEE CA
92584-7001
US

V. Phone/Fax

Practice location:
  • Phone: 951-398-6009
  • Fax:
Mailing address:
  • Phone: 951-398-6009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. STANISHA THOMASINA YORK
Title or Position: CEO
Credential: LPCC
Phone: 909-510-1584