Healthcare Provider Details

I. General information

NPI: 1104567072
Provider Name (Legal Business Name): WELLNESS GROWTH & HEALING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10404 ARTEMIS CT
SPRING VALLEY CA
91977-7143
US

IV. Provider business mailing address

10404 ARTEMIS CT
SPRING VALLEY CA
91977-7143
US

V. Phone/Fax

Practice location:
  • Phone: 773-562-7943
  • Fax:
Mailing address:
  • Phone:
  • 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: MONIQUE LITTLE
Title or Position: CEO/OWNER
Credential:
Phone: 773-562-7943