Provider Demographics
NPI:1033701636
Name:WOLTMON, LACONA (LMFT)
Entity Type:Individual
Prefix:
First Name:LACONA
Middle Name:
Last Name:WOLTMON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4546 EL CAMINO REAL STE 242
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1069
Mailing Address - Country:US
Mailing Address - Phone:650-397-1062
Mailing Address - Fax:
Practice Address - Street 1:4546 EL CAMINO REAL STE 242
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1069
Practice Address - Country:US
Practice Address - Phone:650-397-1062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90893106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist