Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 01-043373 | CA |
Y | 101YM0800X | Mental Health Counselor | 76232 | CA |
NPI | 1003168832 |
---|---|
Provider Name | Kim Wynia |
First Address | Long Beach, CA 90805-1619 |
Second Address | Long Beach, CA 90805-1619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2012 |
Last Update Date | 22/08/2013 |