Organization Name: | PSYCHOLOGICAL WELLNESS |
NPI Number: | 1134375983 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | VIVIAN CREDIDIO (DIRECTOR) |
Mailing Address: | 806 Manhattan Beach Blvd Ste. 207 Manhattan Beach |
State: | CA US |
Postal Code: | 902664935 |
Phone Number: | 3103763388 |
Fax Number: | 3103720198 |
NPI Enumeration Date: | 08/12/2008 |
NPI Last Update Date: | 08/12/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY10441 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |