Provider Demographics
NPI:1033243001
Name:WOLOWODIUK, ADRIENNE EUSEBIO (LCSW)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:EUSEBIO
Last Name:WOLOWODIUK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:EUSEBIO
Other - Last Name:CUENCA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:916-585-7912
Mailing Address - Fax:877-479-7101
Practice Address - Street 1:6339 MACK RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-4655
Practice Address - Country:US
Practice Address - Phone:562-499-6191
Practice Address - Fax:562-499-6171
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
CA7309104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical