Organization
LAVENDER SOUL CARE
Active
Other names
Lavender Soul Care
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GINGER L WILKERSON LMFT (OWNER)
(562) 413-7028
Entity
Organization
Contact information
Practice address
3930 MARRON AVE, LONG BEACH, CA 90807-3614
(562) 641-5638
Mailing address
3930 MARRON AVE, LONG BEACH, CA 90807-3614
(562) 413-7028
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
06/15/2021
Last updated
06/15/2021
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