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General NPI Number Information
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NPI Number | 1689289944
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Entity Type | Organization
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Legal Business Name | CREATEWELLNESS, LICENSED CLINICAL SOCIAL WORKER CORPORATION
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 03/29/2021
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Provider Practice Location Address
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Address Line | 5250 HAYTER AVENUE
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City | LAKEWOOD
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State | CA
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Zip | 90712
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Country | US
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Telephone | 805-870-5709
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Fax |
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Provider Business Mailing Address
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Address Line | 10303 DORCHESTER ST
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City | BAKERSFIELD
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State | CA
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Zip | 93311-4921
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Country | US
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Telephone | 805-870-5709
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Fax | 844-907-2005
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | KALKIDAN ZERYIHUN
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Credential |
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Telephone | 805-870-5709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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