Individual
MR. ANTONIO WONG-RIVADENEYRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1761 BROADWAY, SUITE 100, VALLEJO, CA 94589-2226
(707) 645-2341
(707) 645-2181
Mailing address
1761 BROADWAY, SUITE 100, VALLEJO, CA 94589-2226
(707) 645-2341
(707) 645-2181
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCS10296
CA
Other
Enumeration date
01/11/2007
Last updated
07/08/2007
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