Provider Demographics
NPI:1801813381
Name:WEATHINGTON, ANNETTE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:
Last Name:WEATHINGTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26027
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92406-0727
Mailing Address - Country:US
Mailing Address - Phone:909-475-1777
Mailing Address - Fax:909-475-1700
Practice Address - Street 1:408 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-4414
Practice Address - Country:US
Practice Address - Phone:909-475-1777
Practice Address - Fax:909-475-1700
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA219511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical