Individual
IMOGEN WORMWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4415 SONOMA HWY, SANTA ROSA, CA 95409-7100
(707) 327-0909
Mailing address
447 SEBASTOPOL AVE, SANTA ROSA, CA 95401-8502
(707) 766-4810
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251300000X
Local Education Agency (LEA)
Primary
—
CA
Other
Enumeration date
05/17/2021
Last updated
09/04/2025
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