Provider Demographics
NPI:1942650239
Name:GRATEFUL HEART HOLISTIC THERAPY CENTER
Entity Type:Organization
Organization Name:GRATEFUL HEART HOLISTIC THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RAWNA
Authorized Official - Middle Name:CHERI
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:415-533-9724
Mailing Address - Street 1:360 GRAND AVE
Mailing Address - Street 2:#46
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4840
Mailing Address - Country:US
Mailing Address - Phone:510-394-5065
Mailing Address - Fax:
Practice Address - Street 1:360 GRAND AVE
Practice Address - Street 2:#46
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4840
Practice Address - Country:US
Practice Address - Phone:510-394-5065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty