Individual
AGATHA ANN WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
500 CITY PKWY W, ORANGE, CA 92868-2941
(714) 916-8601
Mailing address
500 CITY PKWY W, ORANGE, CA 92868-2941
(714) 916-8601
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
CA
106H00000X
Marriage & Family Therapist
—
CA
Other
Enumeration date
09/08/2016
Last updated
08/30/2022
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