Provider Demographics
NPI:1235904384
Name:WYNNING FOUNDATION, INC.
Entity Type:Organization
Organization Name:WYNNING FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WYNN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-212-7774
Mailing Address - Street 1:34830 FONTANA DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-5732
Mailing Address - Country:US
Mailing Address - Phone:313-212-7774
Mailing Address - Fax:
Practice Address - Street 1:5150 E PACIFIC COAST HWY STE 200
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3399
Practice Address - Country:US
Practice Address - Phone:313-212-7774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty