Provider Demographics
NPI:1811072424
Name:WONG, DIANA L (MFT)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:L
Last Name:WONG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 JOHN MUIR DRIVE D617
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-6157
Mailing Address - Country:US
Mailing Address - Phone:415-942-9287
Mailing Address - Fax:415-737-0609
Practice Address - Street 1:615 JOHN MUIR DRIVE D617
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-6157
Practice Address - Country:US
Practice Address - Phone:415-942-9287
Practice Address - Fax:415-737-0609
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43649106H00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor