Provider Demographics
NPI:1598818015
Name:QUENICKA, WHILLMA
Entity Type:Individual
Prefix:MRS
First Name:WHILLMA
Middle Name:
Last Name:QUENICKA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:WHILLMA
Other - Middle Name:
Other - Last Name:QUENICKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4607 DEL RAYO CT
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-4026
Mailing Address - Country:US
Mailing Address - Phone:805-525-4669
Mailing Address - Fax:805-525-5779
Practice Address - Street 1:625 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2608
Practice Address - Country:US
Practice Address - Phone:805-525-4669
Practice Address - Fax:805-525-5779
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)