Provider Demographics
NPI:1942336342
Name:WONG, COLLEEN TWEED (LMFT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:TWEED
Last Name:WONG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 SANTA YNEZ WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5427
Mailing Address - Country:US
Mailing Address - Phone:916-492-9007
Mailing Address - Fax:916-492-9396
Practice Address - Street 1:720 ALHAMBRA BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3825
Practice Address - Country:US
Practice Address - Phone:916-492-9007
Practice Address - Fax:916-492-9396
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96875106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist