Provider Demographics
NPI:1972864320
Name:JEFFERY D. WILFONG, MARRIAGE, CHILD, AND FAMILY COUNSELING, INC.
Entity type:Organization
Organization Name:JEFFERY D. WILFONG, MARRIAGE, CHILD, AND FAMILY COUNSELING, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:WILFONG
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:888-511-4269
Mailing Address - Street 1:PO BOX 191381
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-1381
Mailing Address - Country:US
Mailing Address - Phone:888-511-4269
Mailing Address - Fax:888-511-4258
Practice Address - Street 1:900 FULTON AVE STE 270
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4516
Practice Address - Country:US
Practice Address - Phone:888-511-4269
Practice Address - Fax:888-511-4258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFCC 46654106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty