Individual
DR. PHYLIS JANE WAKEFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1151 BROADWAY, SUITE 202, SONOMA, CA 95476-7571
(770) 722-2624
Mailing address
PO BOX 97, SONOMA, CA 95476-0097
(707) 222-6242
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
PSY14649
CA
103TB0200X
Cognitive & Behavioral Psychologist
PSY14649
CA
103TC0700X
Clinical Psychologist
PSY14649
CA
103TP2701X
Group Psychotherapy Psychologist
PSY14649
CA
Other
Enumeration date
01/11/2007
Last updated
03/03/2010
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