Provider Demographics
NPI:1689289944
Name:CREATEWELLNESS, LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity Type:Organization
Organization Name:CREATEWELLNESS, LICENSED CLINICAL SOCIAL WORKER CORPORATION
Other - Org Name:CREATEWELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KALKIDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZERYIHUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-870-5709
Mailing Address - Street 1:10303 DORCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-4921
Mailing Address - Country:US
Mailing Address - Phone:805-870-5709
Mailing Address - Fax:844-907-2005
Practice Address - Street 1:5250 HAYTER AVENUE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712
Practice Address - Country:US
Practice Address - Phone:805-870-5709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty