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General NPI Number Information
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NPI Number | 1609658616
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Entity Type | Organization
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Legal Business Name | WEAVING WELLNESS & DIVERSITY MANAGEMENT COMPANY
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 6248 5TH AVENUE
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City | LUCERNE
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State | CA
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Zip | 95458
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Country | US
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Telephone | 707-391-9030
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Fax |
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Provider Business Mailing Address
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Address Line | 2203 ROAD H
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City | REDWOOD VALLEY
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State | CA
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Zip | 95470-9521
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Country | US
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Telephone | 707-391-9030
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Fax |
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Authorized Official
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Title or Position | CEO/EXECUTIVE DIRECTOR
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Name | BRIAN WILLIAMS
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Credential | MS
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Telephone | 707-391-9030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #3
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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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