Provider Demographics
NPI:1679234553
Name:WATSON-WONG, JOANNA MARY (LMFT, LCMFT)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:MARY
Last Name:WATSON-WONG
Suffix:
Gender:F
Credentials:LMFT, LCMFT
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:MARY
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 798
Mailing Address - Street 2:#20211091
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66601-0798
Mailing Address - Country:US
Mailing Address - Phone:650-455-5040
Mailing Address - Fax:
Practice Address - Street 1:2501 EAST CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214
Practice Address - Country:US
Practice Address - Phone:650-455-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS829106H00000X
CA30508106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist