Provider Demographics
NPI:1417759788
Name:CENTRAL COAST EMOTIONAL WELLNESS LICENSED CLINICAL SOCIAL WORKER
Entity type:Organization
Organization Name:CENTRAL COAST EMOTIONAL WELLNESS LICENSED CLINICAL SOCIAL WORKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GIZELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:805-400-3721
Mailing Address - Street 1:201 S MILLER ST STE 107
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5248
Mailing Address - Country:US
Mailing Address - Phone:805-400-3721
Mailing Address - Fax:805-614-7126
Practice Address - Street 1:201 S MILLER ST STE 107
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5248
Practice Address - Country:US
Practice Address - Phone:805-400-3721
Practice Address - Fax:805-614-7126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty