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General NPI Number Information
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NPI Number | 1992487243
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Entity Type | Organization
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Legal Business Name | WELLNESS COMPANY A CA FAMILY THERAPIST PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/07/2023
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 1212 W GARDENA BLVD STE B
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City | GARDENA
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State | CA
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Zip | 90247-4896
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Country | US
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Telephone | 209-361-4281
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 690986
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City | STOCKTON
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State | CA
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Zip | 95269-0986
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Country | US
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Telephone | 209-361-4281
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Fax |
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Authorized Official
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Title or Position | CEO, CFO, SECRETARY, AND DIRECTOR
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Name | MS. ANIKA J. GRANT
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Credential | LMFT
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Telephone | 209-361-4281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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