Provider Demographics
NPI:1659685717
Name:HOUSE OF HEALING, INC.
Entity Type:Organization
Organization Name:HOUSE OF HEALING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SIDDIQI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:805-925-5776
Mailing Address - Street 1:920 S BROADWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6641
Mailing Address - Country:US
Mailing Address - Phone:805-925-5776
Mailing Address - Fax:805-929-5683
Practice Address - Street 1:920 S BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6662
Practice Address - Country:US
Practice Address - Phone:805-925-5776
Practice Address - Fax:805-929-5683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-01
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 56311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497887483OtherCAL-WORKS
1497887483OtherVICTIM COMPENSATION PROGRAM