Provider Demographics
NPI:1588831853
Name:PARKER, WENDY CARROLL (MA, AMFT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:CARROLL
Last Name:PARKER
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-1920
Mailing Address - Country:US
Mailing Address - Phone:415-722-6951
Mailing Address - Fax:
Practice Address - Street 1:2633 66TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-1920
Practice Address - Country:US
Practice Address - Phone:415-722-6951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121183106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist