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General NPI Number Information
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NPI Number | 1417759788
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Entity Type | Organization
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Legal Business Name | CENTRAL COAST EMOTIONAL WELLNESS LICENSED CLINICAL SOCIAL WORKER
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 201 S MILLER ST STE 107
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City | SANTA MARIA
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State | CA
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Zip | 93454-5248
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Country | US
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Telephone | 805-400-3721
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Fax | 805-614-7126
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Provider Business Mailing Address
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Address Line | 201 S MILLER ST STE 107
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City | SANTA MARIA
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State | CA
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Zip | 93454-5248
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Country | US
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Telephone | 805-400-3721
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Fax | 805-614-7126
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Authorized Official
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Title or Position | PRESIDENT
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Name | GIZELLE MENDOZA
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Credential | LCSW
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Telephone | 805-400-3721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 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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