Provider Demographics
NPI:1700383718
Name:WHOLE SOUL COUNSELING A LICENSED CLINICAL SOCIAL WORKER PC
Entity Type:Organization
Organization Name:WHOLE SOUL COUNSELING A LICENSED CLINICAL SOCIAL WORKER PC
Other - Org Name:THE WHOLE SOUL COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:KRISTINA
Authorized Official - Last Name:MAHAKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:916-877-6894
Mailing Address - Street 1:4005 MANZANITA AVENUE
Mailing Address - Street 2:SUITE 6, #434
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4125 TEMESCAL ST STE A
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7558
Practice Address - Country:US
Practice Address - Phone:916-877-6894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-07
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA821461041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty