Individual
GRACE WAKIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
3900 LAKEVILLE HWY, MOB 2, PETALUMA, CA 94954-5968
(707) 765-3565
Mailing address
1160 N DUTTON AVE, STE 230, SANTA ROSA, CA 95401-4658
(707) 303-3243
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
29666
CA
Other
Enumeration date
02/06/2018
Last updated
04/22/2019
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