Provider Demographics
NPI:1598245458
Name:THE WELLNESS ARTS COLLECTIVE MARRIAGE & FAMILY THERAPY CORPORATION
Entity Type:Organization
Organization Name:THE WELLNESS ARTS COLLECTIVE MARRIAGE & FAMILY THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, LICENSED MFT
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WALLER-DANG
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, ATR
Authorized Official - Phone:323-536-1640
Mailing Address - Street 1:4622A HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5408
Mailing Address - Country:US
Mailing Address - Phone:323-536-1640
Mailing Address - Fax:
Practice Address - Street 1:4622A HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5408
Practice Address - Country:US
Practice Address - Phone:323-536-1640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107844101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty