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General NPI Number Information
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NPI Number | 1679421747
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Entity Type | Organization
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Legal Business Name | INDIGENA INTEGRATIVE WELLNESS A LICENSED CLINICAL SOCIAL WORKER, PC
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Dates
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Enumeration Date | 03/17/2026
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Last Update Date | 03/17/2026
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Provider Practice Location Address
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Address Line | 6049 DOUGLAS BLVD STE 20B
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City | GRANITE BAY
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State | CA
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Zip | 95746-6275
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Country | US
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Telephone | 408-460-5030
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Fax |
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Provider Business Mailing Address
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Address Line | 12120 HERDAL DR
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City | AUBURN
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State | CA
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Zip | 95603-5637
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Country | US
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Telephone | 408-460-5030
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | REGINA FARIDNIA
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Credential | LCSW, PHD, IMD
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Telephone | 408-460-5030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 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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Taxonomy #4
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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Taxonomy #7
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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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Taxonomy #8
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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