Healthcare Provider Details

I. General information

NPI: 1801113675
Provider Name (Legal Business Name): CAROLYN ASHLEY WANYONYI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SKYLINE BLVD
AVENAL CA
93204-1850
US

IV. Provider business mailing address

10925 SOUTHERN HIGHLANDS PKWY APT 1112
LAS VEGAS NV
89141-4309
US

V. Phone/Fax

Practice location:
  • Phone: 559-386-4500
  • Fax:
Mailing address:
  • Phone: 714-350-0618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60524
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7369-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: