Provider Demographics
NPI:1215229547
Name:WONG, EVERETT D (LCSW)
Entity Type:Individual
Prefix:
First Name:EVERETT
Middle Name:D
Last Name:WONG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5430 E OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90022-5113
Mailing Address - Country:US
Mailing Address - Phone:323-728-9966
Mailing Address - Fax:323-887-1082
Practice Address - Street 1:5430 E OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90022-5113
Practice Address - Country:US
Practice Address - Phone:323-728-9966
Practice Address - Fax:323-887-1082
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker