Provider Demographics
NPI:1992487243
Name:WELLNESS COMPANY A CA FAMILY THERAPIST PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:WELLNESS COMPANY A CA FAMILY THERAPIST PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CFO, SECRETARY, AND DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANIKA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:209-361-4281
Mailing Address - Street 1:PO BOX 690986
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95269-0986
Mailing Address - Country:US
Mailing Address - Phone:209-361-4281
Mailing Address - Fax:
Practice Address - Street 1:1212 W GARDENA BLVD STE B
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4896
Practice Address - Country:US
Practice Address - Phone:209-361-4281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty