Provider Demographics
NPI:1982581864
Name:WONG, MARIE ELLINOR CORRAL
Entity type:Individual
Prefix:
First Name:MARIE ELLINOR
Middle Name:CORRAL
Last Name:WONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIE ELLINOR
Other - Middle Name:CORRAL
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4281 KATELLA AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-6515
Mailing Address - Country:US
Mailing Address - Phone:626-270-9400
Mailing Address - Fax:626-270-9400
Practice Address - Street 1:4281 KATELLA AVE STE 207
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6515
Practice Address - Country:US
Practice Address - Phone:626-270-9400
Practice Address - Fax:626-270-9400
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist