Provider Demographics
NPI:1316644529
Name:WILT, VERONICA KATHRYN (AMFT #136435)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:KATHRYN
Last Name:WILT
Suffix:
Gender:F
Credentials:AMFT #136435
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 FOX FIELD LN
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7127
Mailing Address - Country:US
Mailing Address - Phone:706-627-5064
Mailing Address - Fax:
Practice Address - Street 1:110 S C ST STE C
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7340
Practice Address - Country:US
Practice Address - Phone:805-710-8857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist