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NPI Code Detail

MEDICARE: MRS. WENDY DAWN PARKER CADC-CAS

MEDICARE: MRS. WENDY DAWN PARKER CADC-CAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2101YA0400XAddiction (Substance Use Disorder) CounselorC033920715CA

General Provider Information

NPI Number : 1336505858
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. WENDY DAWN PARKER CADC-CAS
Provider Business Mailing Address
First Line : 1260 MORENA BLVD STE 100
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-3850
Country : US
Telephone Number : 619-398-0355
Fax Number :
Provider Business Practice Location Address
First Line : 3594 4TH AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-4989
Country : US
Telephone Number : 619-296-1151
Fax Number : 619-296-6218
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2016
Last Update Date : 06/26/2023

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