Provider Demographics
NPI:1770445686
Name:RAFIKI WANGE MENTAL HEALTH SERVICES CORPORATION
Entity type:Organization
Organization Name:RAFIKI WANGE MENTAL HEALTH SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:REXELLA
Authorized Official - Last Name:KWOBA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-209-5049
Mailing Address - Street 1:1121 FOURTH AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2800
Mailing Address - Country:US
Mailing Address - Phone:858-209-5049
Mailing Address - Fax:
Practice Address - Street 1:1121 FOURTH AVE APT 206
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2800
Practice Address - Country:US
Practice Address - Phone:858-209-5049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-29
Last Update Date:2025-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty