Provider Demographics
NPI:1104981554
Name:WHITEAKER, LYNN MARIE (MFT)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:MARIE
Last Name:WHITEAKER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4706 REDLAND DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-2210
Mailing Address - Country:US
Mailing Address - Phone:619-582-4147
Mailing Address - Fax:619-582-4147
Practice Address - Street 1:4215 SPRING ST
Practice Address - Street 2:SUITE 210B
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7965
Practice Address - Country:US
Practice Address - Phone:619-589-8971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 25943106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist