Provider Demographics
NPI:1710270400
Name:DULCEY-WANG, KRISTINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:
Last Name:DULCEY-WANG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 TIENDA DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-3934
Mailing Address - Country:US
Mailing Address - Phone:209-286-6442
Mailing Address - Fax:
Practice Address - Street 1:1930 TIENDA DR STE 102
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3934
Practice Address - Country:US
Practice Address - Phone:209-286-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23297103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical