WAKANDA ROSE (NPI# 1689128001) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689128001 |
| Entity Type | Individual |
| Full Name | WAKANDA ROSE |
| Credential | MA |
| Practice Address |
254 Brey Rd Santa Rosa CA 95409-5556 |
| Practice Telephone | 7075839304 |
| Mailing Telephone | 7075839304 |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2016-08-15 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| Street Address |
254 BREY RD |
| City | SANTA ROSA |
| State | CA |
| Zip Code | 95409-5556 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568005205 | Angela Tejeda | Counselor | 35555 Sonoma Hwy, Santa Rosa, CA 95409 | 2019-10-25 |
| 1609335314 | Heidi Diebel | Marriage & Family Therapist | 9291 Oak Trail Cir, Santa Rosa, CA 95409 | 2019-03-13 |
| 1427525328 | Christopher William Schouest | Behavioral Analyst | 5424 Sharon St., Santa Rosa, CA 95409 | 2018-10-29 |
| 1194178756 | Ana Ceniceros | Registered Nurse | 7425 Los Guilucos Rd, Santa Rosa, CA 95409 | 2016-07-19 |
| 1669842878 | Kimberly Harris | Counselor | 7425 Los Guilicos Rd., Dept. H, Santa Rosa, CA 95409 | 2015-09-30 |
| 1568884849 | Christopher Cincotta | Counselor | 540 Middle Rincon Road, Santa Rosa, CA 95409 | 2014-01-06 |
| 1104186626 | Gina Ruth Sarpy | Marriage & Family Therapist | 7425 Los Guilicos Rd, Dept. H, Santa Rosa, CA 95409 | 2012-05-17 |
| 1467745950 | Courtney King | Family Medicine | 4702 Starbuck Ave, Santa Rosa, CA 95409 | 2011-05-17 |
| 1427351162 | Robert E Richardson Md Professional Corp. | Surgery | 1812 Happy Valley Road, Santa Rosa, CA 95409 | 2010-12-20 |
| 1497063564 | Edmundo Simon Martinez IIi IIi | Occupational Therapist | 5555 Montgomery Dr., Santa Rosa, CA 95409 | 2010-09-22 |
| Find all providers in zip 95409 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205442217 | David Lee Dutton | Counselor | 201 S. E Street, Santa Rosa, CA 95404 | 2020-09-16 |
| 1730710260 | Harold Joseph Bahr | Counselor | 1550 N Dutton Ave, Santa Rosa, CA 95401-4601 | 2020-02-03 |
| 1801432398 | William Carroll | Counselor | 1260 N Dutton Ave Ste 185, Santa Rosa, CA 95401-7146 | 2019-11-20 |
| 1497390462 | Emily Sue Hamp | Counselor | 1202 Woodlake Dr, Santa Rosa, CA 95405-9217 | 2019-11-13 |
| 1316410640 | Lionel C Cooper | Counselor | 315 Mark West Springs Road, Santa Rosa, CA 95403 | 2019-01-09 |
| 1174005540 | Amal Saeed Ahmed | Counselor | 2908 Bay Village Cir Apt 2108, Santa Rosa, CA 95403-3611 | 2018-09-03 |
| 1114436060 | Lacey Lynn Palmer | Counselor | 341 Irwin Lane, Santa Rosa, CA 95401 | 2017-09-22 |
| 1992223192 | Jill Mcculloch | Counselor | 300 Stony Point Rd Apt 190, Santa Rosa, CA 95401-5960 | 2017-09-07 |
| 1497299325 | Janice Anne Myers | Counselor | 3746 Oregon Dr, Santa Rosa, CA 95405-7136 | 2016-12-12 |
| 1982076949 | Deanna L Wolfe | Counselor | 3952 Sebastopol Rd, Suite 180, Santa Rosa, CA 95407-6677 | 2015-10-29 |
| Find all providers in SANTA ROSA | ||||
| City | SANTA ROSA |
| Zip Code | 95409 |
Please comment or provide details below to improve the information on WAKANDA ROSE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.