Provider Demographics
NPI:1376305664
Name:WELLNESS WITHIN PSYCHOTHERAPY & CONSULTING PC
Entity Type:Organization
Organization Name:WELLNESS WITHIN PSYCHOTHERAPY & CONSULTING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NORVAL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD, MPH
Authorized Official - Phone:858-405-6334
Mailing Address - Street 1:604 MILITARY E
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3551
Mailing Address - Country:US
Mailing Address - Phone:858-405-6334
Mailing Address - Fax:
Practice Address - Street 1:175 E PROSPECT AVE STE 2A
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3866
Practice Address - Country:US
Practice Address - Phone:510-982-1000
Practice Address - Fax:510-210-9310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty