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Organization
COMMUNITY WELLNESS GROUP
Active
Organization
COMMUNITY WELLNESS GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY NIBO LCSW (PRESIDENT)
(818) 858-6031
Entity
Organization
Contact information
Practice address
11311 HAWTHORNE BLVD UNIT 1, INGLEWOOD, CA 90304-2775
(818) 858-6031
Mailing address
6709 LA TIJERA BLVD UNIT 1025, LOS ANGELES, CA 90045-2017
(818) 858-6031
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
172V00000X
Community Health Worker
—
—
251B00000X
Case Management Agency
—
—
Other
Enumeration date
03/03/2026
Last updated
03/03/2026
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