Provider Demographics
NPI:1700275955
Name:WYNTER, NADIA
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:WYNTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2166 HAYES ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1033
Mailing Address - Country:US
Mailing Address - Phone:415-776-1001
Mailing Address - Fax:415-776-1066
Practice Address - Street 1:2166 HAYES ST
Practice Address - Street 2:SUITE 303
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1033
Practice Address - Country:US
Practice Address - Phone:415-776-1001
Practice Address - Fax:415-776-1066
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01-70101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)