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General NPI Number Information
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NPI Number | 1164336269
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Entity Type | Organization
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Legal Business Name | GLOW WITH WELLNESS THERAPY, LICENSED CLINICAL SOCIAL WORKER
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 3555 ROSECRANS ST STE 114-134
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City | SAN DIEGO
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State | CA
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Zip | 92110-3231
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Country | US
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Telephone | 858-326-1810
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Fax | 858-326-2043
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Provider Business Mailing Address
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Address Line | 3555 ROSECRANS ST STE 114-134
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City | SAN DIEGO
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State | CA
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Zip | 92110-3231
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Country | US
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Telephone | 858-326-1810
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Fax | 858-326-2043
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | SHEILA KUBOTA
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Credential | LCSW, PMH-C
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Telephone | 858-326-1810
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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 | NULL
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