Provider Demographics
NPI:1386187037
Name:WAINAINA, WAMBUI (LCSW)
Entity Type:Individual
Prefix:
First Name:WAMBUI
Middle Name:
Last Name:WAINAINA
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 1:3031 W MARCH LN
Mailing Address - Street 2:STE 216W
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-6500
Mailing Address - Country:US
Mailing Address - Phone:209-988-2645
Mailing Address - Fax:209-956-9595
Practice Address - Street 1:3031 W MARCH LN
Practice Address - Street 2:STE 216W
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-6500
Practice Address - Country:US
Practice Address - Phone:209-988-2645
Practice Address - Fax:209-956-9595
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW64800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker