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General NPI Number Information
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NPI Number | 1679357107
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Entity Type | Organization
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Legal Business Name | WILLING 2 MOVE FORWARD
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Dates
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Enumeration Date | 08/24/2023
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 5543 ATLANTIC AVE STE B
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City | LONG BEACH
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State | CA
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Zip | 90805-5412
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Country | US
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Telephone | 562-612-1524
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 OLIVE AVE
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City | LONG BEACH
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State | CA
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Zip | 90813-3521
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Country | US
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Telephone | 562-528-2139
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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. MICHELLE ANNE TALBOTT
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Credential |
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Telephone | 562-528-2139
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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