Provider Demographics
NPI:1487892444
Name:WIGHTMAN, NICHOLAS (MA, LMFT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:WIGHTMAN
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 TELEGRAPH AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1371
Mailing Address - Country:US
Mailing Address - Phone:510-717-9957
Mailing Address - Fax:
Practice Address - Street 1:6355 TELEGRAPH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1371
Practice Address - Country:US
Practice Address - Phone:510-717-9957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52065106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist