Provider Demographics
NPI:1760981278
Name:MIHARA-WOLLENBERG, AKIKO (MA)
Entity Type:Individual
Prefix:
First Name:AKIKO
Middle Name:
Last Name:MIHARA-WOLLENBERG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:AKIKO
Other - Middle Name:
Other - Last Name:MIHARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:550 N FLOWER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-2361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 N FLOWER ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-2361
Practice Address - Country:US
Practice Address - Phone:714-647-4666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health