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General NPI Number Information
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NPI Number | 1063334944
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Entity Type | Organization
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Legal Business Name | FLW LIVING WELL SERVICES
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 301 GEORGIA ST STE 316
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City | VALLEJO
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State | CA
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Zip | 94590-5997
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Country | US
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Telephone | 510-221-6652
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Fax |
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Provider Business Mailing Address
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Address Line | 100 ADMIRAL CALLAGHAN LN UNIT 5176
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City | VALLEJO
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State | CA
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Zip | 94591-3209
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Country | US
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Telephone | 510-221-6652
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | FREDERICKA WHITE
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Credential |
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Telephone | 510-221-6652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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