Provider Demographics
NPI:1376881706
Name:WINGATE, NOELLE ANGELA (LMFT)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:ANGELA
Last Name:WINGATE
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 1:13706 HOLLOWBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-8827
Mailing Address - Country:US
Mailing Address - Phone:951-295-2856
Mailing Address - Fax:951-734-2082
Practice Address - Street 1:1451 RIMPAU AVE STE 209
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-7522
Practice Address - Country:US
Practice Address - Phone:951-295-2856
Practice Address - Fax:951-734-2082
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41034106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist