Healthcare Provider Details

I. General information

NPI: 1437918331
Provider Name (Legal Business Name): WELLNESS & PREVENTION LICENSED CLINICAL SOCIAL WORKER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27125 CALLE ARROYO
SAN JUAN CAPISTRANO CA
92675-2763
US

IV. Provider business mailing address

27125 CALLE ARROYO
SAN JUAN CAPISTRANO CA
92675-2763
US

V. Phone/Fax

Practice location:
  • Phone: 949-680-0516
  • Fax:
Mailing address:
  • Phone: 949-680-0516
  • 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: SUSAN PARMELEE
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 949-680-0516