Healthcare Provider Details

I. General information

NPI: 1548102221
Provider Name (Legal Business Name): PRIDE ROCK WELLNESS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N EL MOLINA AVE
PASADENA CA
91101
US

IV. Provider business mailing address

254 N LAKE AVE # 154
PASADENA CA
91101-1829
US

V. Phone/Fax

Practice location:
  • Phone: 626-529-3725
  • Fax:
Mailing address:
  • Phone: 626-529-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ERIC WARREN JR.
Title or Position: CEO
Credential:
Phone: 323-599-6248