Weaving Wellness & Diversity Management Company

Primary specialty

Prevention ProfessionalTaxonomy code 405300000X

Legal business name

WEAVING WELLNESS & DIVERSITY MANAGEMENT COMPANY

Practice address

6248 5TH Avenue
Lucerne, CA 95458

Phone

(707) 391-9030

NPI assigned

Oct 16, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brian Williams, MS

Title

Ceo/Executive Director

Phone

(707) 391-9030

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1697414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697414400000",
    "number": "1609658616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2203 ROAD H",
            "city": "REDWOOD VALLEY",
            "state": "CA",
            "postal_code": "954709521",
            "telephone_number": "707-391-9030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6248 5TH AVENUE",
            "city": "LUCERNE",
            "state": "CA",
            "postal_code": "95458",
            "telephone_number": "707-391-9030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEAVING WELLNESS & DIVERSITY MANAGEMENT COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-16",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-14",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CEO/EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "707-391-9030",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "405300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Prevention Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawna Dee Theodorou
• Kevin Lee Thompson
• Jamilyn D Trillo, LCSW
• Kristin Valeski, LCSW
• Paul J Verhey, CATC II
• Amber Marie Westphal
• James Wilkie
• Maitea Joy Williams
• Leslie Ann Wilson, LMFT
• Teresa Lynn Wilson

• Prevention Professional in Lucerne, CA
• Providers in Lucerne, CA by specialty
• Prevention Professional in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.