Provider Demographics
NPI:1780062968
Name:WIMSATT, ANNA (CADC-CAS)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:WIMSATT
Suffix:
Gender:F
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 W FREDKIN DR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-3114
Mailing Address - Country:US
Mailing Address - Phone:626-298-1389
Mailing Address - Fax:
Practice Address - Street 1:1450 N LAKE AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2301
Practice Address - Country:US
Practice Address - Phone:626-564-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)