Provider Demographics
NPI:1760865794
Name:DEEP WELLNESS CENTER CHILD & FAMILY INC
Entity Type:Organization
Organization Name:DEEP WELLNESS CENTER CHILD & FAMILY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE & FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RAMANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:DHALIWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMFT
Authorized Official - Phone:209-665-6857
Mailing Address - Street 1:5815 STODDARD RD STE 600
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9041
Mailing Address - Country:US
Mailing Address - Phone:209-665-6857
Mailing Address - Fax:
Practice Address - Street 1:5815 STODDARD RD STE 600
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9041
Practice Address - Country:US
Practice Address - Phone:209-665-6857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X, 101YM0800X, 103TC0700X, 1041C0700X
CALMFT 52611106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty