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General NPI Number Information
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NPI Number | 1699400788
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Entity Type | Organization
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Legal Business Name | CENTENNIAL HARVEST WELLNESS INSTITUTE
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Dates
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Enumeration Date | 07/21/2022
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2330 E DEL MAR BLVD
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City | PASADENA
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State | CA
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Zip | 91107
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Country | US
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Telephone | 323-917-1195
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Fax |
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Provider Business Mailing Address
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Address Line | 3355 N WHITE AVE UNIT 8287
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City | LA VERNE
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State | CA
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Zip | 91750-6207
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Country | US
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Telephone | 323-917-1195
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Fax |
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Authorized Official
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Title or Position | PRESIDENT-CEO
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Name | MS. LEEANN MARIE NABORS
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Credential |
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Telephone | 323-917-1195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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