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General NPI Number Information
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NPI Number | 1366282188
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Entity Type | Organization
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Legal Business Name | HEALED WOMEN HEAL, INC.
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 436 W 4TH ST # 225
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City | POMONA
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State | CA
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Zip | 91766-1622
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Country | US
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Telephone | 909-815-7815
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Fax |
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Provider Business Mailing Address
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Address Line | 436 W 4TH ST # 225
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City | POMONA
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State | CA
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Zip | 91766-1622
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Country | US
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Telephone | 909-815-7815
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. TRACY EVANSON
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Credential | MS
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Telephone | 909-815-7815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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