Provider Demographics
NPI:1205846581
Name:DWIGHT, AILEEN C (LCSW)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:C
Last Name:DWIGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AILEEN
Other - Middle Name:CUNANAN
Other - Last Name:DWIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1420 WILLOW PASS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5823
Mailing Address - Country:US
Mailing Address - Phone:256-465-4809
Mailing Address - Fax:925-646-5622
Practice Address - Street 1:1420 WILLOW PASS RD STE 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5823
Practice Address - Country:US
Practice Address - Phone:925-646-5480
Practice Address - Fax:925-646-5622
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 234481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical