Provider Demographics
NPI:1497944482
Name:CHAN, WAI WAI VICKY (MFT)
Entity Type:Individual
Prefix:MISS
First Name:WAI WAI
Middle Name:VICKY
Last Name:CHAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 BALBOA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-2569
Mailing Address - Country:US
Mailing Address - Phone:415-668-5998
Mailing Address - Fax:415-668-5996
Practice Address - Street 1:4020 BALBOA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-2569
Practice Address - Country:US
Practice Address - Phone:415-668-5998
Practice Address - Fax:415-668-5996
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 46323106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist