Provider Demographics
NPI:1700908357
Name:KORDICH, WINIFRED (MA MFT)
Entity Type:Individual
Prefix:MS
First Name:WINIFRED
Middle Name:
Last Name:KORDICH
Suffix:
Gender:F
Credentials:MA MFT
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 5681
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92846-0681
Mailing Address - Country:US
Mailing Address - Phone:714-686-8427
Mailing Address - Fax:
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6335
Practice Address - Country:US
Practice Address - Phone:714-686-8427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48366106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist