Healthcare Provider Details

I. General information

NPI: 1144840349
Provider Name (Legal Business Name): WHOLE LIFE PATHWAYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37012 32ND ST E
PALMDALE CA
93550-6674
US

IV. Provider business mailing address

37012 32ND ST E
PALMDALE CA
93550-6674
US

V. Phone/Fax

Practice location:
  • Phone: 323-605-6579
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. JERMAINE JUNIUS
Title or Position: OWNER
Credential:
Phone: 323-605-6579