Provider Demographics
NPI:1811023310
Name:WONG, GARNETT LYNN DITTFURTH (LPC)
Entity Type:Individual
Prefix:
First Name:GARNETT
Middle Name:LYNN DITTFURTH
Last Name:WONG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:GARNETT
Other - Middle Name:L
Other - Last Name:DITTFURTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1511 DIVISION ST STE 101
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1589
Mailing Address - Country:US
Mailing Address - Phone:503-722-3705
Mailing Address - Fax:
Practice Address - Street 1:1511 DIVISION ST STE 101
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1589
Practice Address - Country:US
Practice Address - Phone:503-722-3705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4251101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional