Healthcare Provider Details

I. General information

NPI: 1255258042
Provider Name (Legal Business Name): PROGRESSIVE HEALING LICENSED PROFESSIONAL CLINICAL COUNSELOR CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 CAMINO DEL RIO S STE 303
SAN DIEGO CA
92108-3507
US

IV. Provider business mailing address

409 CAMINO DEL RIO S STE 303
SAN DIEGO CA
92108-3507
US

V. Phone/Fax

Practice location:
  • Phone: 619-339-1190
  • Fax:
Mailing address:
  • Phone: 619-339-1190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JONEI PEARL CHAPPLE-SEWELL
Title or Position: CEO/LICENSED CLINICIAN
Credential: LPCC 13918
Phone: 619-339-1190