Basic Information
| Provider Information | |||||||||
| NPI: | 1689024176 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WIN | ||||||||
| FirstName: | CAROL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6221 GEARY BLVD | ||||||||
| Address2: | #2 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941211887 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6221 GEARY BLVD | ||||||||
| Address2: | #2 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941211887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153866600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2016 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 12315 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.