Provider Demographics
NPI:1114228905
Name:WILHARDT, LYNNETTE MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LYNNETTE
Middle Name:MARIE
Last Name:WILHARDT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5245
Mailing Address - Street 2:
Mailing Address - City:BALBOA ISLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92662-5245
Mailing Address - Country:US
Mailing Address - Phone:714-417-1171
Mailing Address - Fax:
Practice Address - Street 1:151 KALMUS DR STE C245
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7954
Practice Address - Country:US
Practice Address - Phone:714-417-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS165971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical