Provider Demographics
NPI:1033730072
Name:WHOLENESS EMPOWERMENT GROUP LICENSED CLINICAL SOCIAL WORKER, INC
Entity Type:Organization
Organization Name:WHOLENESS EMPOWERMENT GROUP LICENSED CLINICAL SOCIAL WORKER, INC
Other - Org Name:THE WHOLENESS EMPOWERMENT GROUP INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:AHUNNA
Authorized Official - Last Name:OHAERI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:909-572-3055
Mailing Address - Street 1:2910 S ARCHIBALD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7358
Mailing Address - Country:US
Mailing Address - Phone:909-572-3055
Mailing Address - Fax:877-602-0232
Practice Address - Street 1:22365 BARTON RD STE 302
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5078
Practice Address - Country:US
Practice Address - Phone:909-649-6111
Practice Address - Fax:877-602-0232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty