Basic Information
| Provider Information | |||||||||
| NPI: | 1184979205 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WANIE | ||||||||
| FirstName: | VIOLKA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5960 S LAND PARK DR # 215 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958223313 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 PRISON RD | ||||||||
| Address2: | |||||||||
| City: | REPRESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956713000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169858610 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2012 | ||||||||
| LastUpdateDate: | 07/14/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS26426 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.