Healthcare Provider Details

I. General information

NPI: 1780516401
Provider Name (Legal Business Name): CHRISTOPHER WAYNE WANG-KILDEGAARD AMFT, APCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 F STREET SUITE 3, #725
ARCATA CA
95521
US

IV. Provider business mailing address

PO BOX 3133
OAKLAND CA
94609-0133
US

V. Phone/Fax

Practice location:
  • Phone: 510-547-6751
  • Fax:
Mailing address:
  • Phone: 510-544-6751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC17439
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT148948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: