Provider Demographics
NPI:1770615551
Name:WING, JOSEPH DEGUISA (MA, LMFT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DEGUISA
Last Name:WING
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 GRIFFITH PARK BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-1046
Mailing Address - Country:US
Mailing Address - Phone:323-819-0609
Mailing Address - Fax:
Practice Address - Street 1:2620 INDUSTRY WAY
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-4024
Practice Address - Country:US
Practice Address - Phone:310-631-8004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC #47514106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106H00000XOtherMENTAL HEALTH