Provider Demographics
NPI:1538608179
Name:VAN WORMER, CAITLIN MARIE (AMFT; APCC)
Entity type:Individual
Prefix:MISS
First Name:CAITLIN
Middle Name:MARIE
Last Name:VAN WORMER
Suffix:
Gender:F
Credentials:AMFT; APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 28424
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92809-2233
Mailing Address - Country:US
Mailing Address - Phone:714-850-8402
Mailing Address - Fax:
Practice Address - Street 1:401 W CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4515
Practice Address - Country:US
Practice Address - Phone:714-480-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI 95030106H00000X
CAPCCI 3250101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional