| Wholistic Healing Licensed Clinical Social Worker Inc | |
|
337 N Vineyard Ave Ste 400 Ontario CA 91764-4436 | |
| (626) 201-3569 | |
| Not Available |
| Full Name | Wholistic Healing Licensed Clinical Social Worker Inc |
|---|---|
| Speciality | Social Worker |
| Location | 337 N Vineyard Ave Ste 400, Ontario, California |
| Authorized Official Name and Position | Sally Amaya (PRESIDENT/OWNER) |
| Authorized Official Contact | 6262013569 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wholistic Healing Licensed Clinical Social Worker Inc 337 N Vineyard Ave Ste 400 Ontario CA 91764-4436 Ph: () - | Wholistic Healing Licensed Clinical Social Worker Inc 337 N Vineyard Ave Ste 400 Ontario CA 91764-4436 Ph: (626) 201-3569 |
| NPI Number | 1619715711 |
|---|---|
| Provider Enumeration Date | 07/15/2024 |
| Last Update Date | 07/15/2024 |
| Certification Date | 07/15/2024 |
| Medicare PECOS PAC ID | 3779017637 |
|---|---|
| Medicare Enrollment ID | O20241114002106 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619715711 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Sally Amaya |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013270719 PECOS PAC ID: 1456705292 Enrollment ID: I20230927001547 |
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