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General NPI Number Information
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NPI Number | 1881064715
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Entity Type | Organization
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Legal Business Name | WELLNESS PSYCHIATRY HIGH IMPACT THERAPY
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Dates
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Enumeration Date | 10/05/2015
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 3505 LONG BEACH BLVD SUITE 2D
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City | LONG BEACH
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State | CA
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Zip | 90807-3907
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Country | US
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Telephone | 562-427-3897
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Fax | 562-595-7703
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Provider Business Mailing Address
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Address Line | 3505 LONG BEACH BLVD SUITE 2D
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City | LONG BEACH
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State | CA
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Zip | 90807-3907
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Country | US
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Telephone | 562-427-3897
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Fax | 562-595-7703
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Authorized Official
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Title or Position | CEO
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Name | DR. ALEKSANDRA WIRGA
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Credential | MD
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Telephone | 562-427-3897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | A74338
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License Number State | CA
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