Provider Demographics
NPI:1750405452
Name:WINN, VIRGINIA/GINNY LELAND (MFT)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA/GINNY
Middle Name:LELAND
Last Name:WINN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:GINNY
Other - Middle Name:L
Other - Last Name:WINN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 1275
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-1275
Mailing Address - Country:US
Mailing Address - Phone:310-302-1139
Mailing Address - Fax:
Practice Address - Street 1:610 SANTA MONICA BLVD
Practice Address - Street 2:224
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1632
Practice Address - Country:US
Practice Address - Phone:310-302-1139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 28820106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist