Provider Demographics
NPI:1134244593
Name:WANG, CHRISTY (LMFT)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 FOLSOM CIR
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-3538
Mailing Address - Country:US
Mailing Address - Phone:408-945-9665
Mailing Address - Fax:
Practice Address - Street 1:840 GUADALUPE PKWY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-1714
Practice Address - Country:US
Practice Address - Phone:408-299-3166
Practice Address - Fax:408-971-2651
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 26038106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist