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General NPI Number Information
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NPI Number | 1003168832
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Entity Type | Individual
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Provider Name | KIM WYNIA LMFT, CADC II, FAC
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Gender | Female
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Dates
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Enumeration Date | 10/03/2012
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 12440 FIRESTONE BLVD STE 100
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City | NORWALK
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State | CA
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Zip | 90650-4340
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Country | US
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Telephone | 562-277-1638
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Fax |
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Provider Business Mailing Address
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Address Line | 1422 E ARTESIA BLVD
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City | LONG BEACH
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State | CA
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Zip | 90805-1619
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Country | US
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Telephone | 562-733-7186
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Fax | 562-423-0688
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | W1206081641
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 112305
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License Number State | CA
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