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General NPI Number Information
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NPI Number | 1700383718
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Entity Type | Organization
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Legal Business Name | WHOLE SOUL COUNSELING A LICENSED CLINICAL SOCIAL WORKER PC
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Dates
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Enumeration Date | 04/07/2018
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 4125 TEMESCAL ST STE A
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City | FAIR OAKS
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State | CA
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Zip | 95628-7558
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Country | US
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Telephone | 916-877-6894
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Fax |
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Provider Business Mailing Address
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Address Line | 4005 MANZANITA AVENUE SUITE 6, #434
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City | CARMICHAEL
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State | CA
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Zip | 95608
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | LAUREN KRISTINA MAHAKIAN
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Credential | LCSW
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Telephone | 916-877-6894
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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 | 82146
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License Number State | CA
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Taxonomy #2
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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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