Healthcare Provider Details

I. General information

NPI: 1063334944
Provider Name (Legal Business Name): FLW LIVING WELL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GEORGIA ST STE 316
VALLEJO CA
94590-5997
US

IV. Provider business mailing address

100 ADMIRAL CALLAGHAN LN UNIT 5176
VALLEJO CA
94591-3209
US

V. Phone/Fax

Practice location:
  • Phone: 510-221-6652
  • Fax:
Mailing address:
  • Phone: 510-221-6652
  • 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 Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: FREDERICKA WHITE
Title or Position: CEO
Credential:
Phone: 510-221-6652