Provider Demographics
NPI:1447536958
Name:WENRICK, JAMES LYNN (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LYNN
Last Name:WENRICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:L
Other - Last Name:WENRICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:5942 EDINGER AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-1773
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5942 EDINGER AVE STE 113
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-1773
Practice Address - Country:US
Practice Address - Phone:714-296-1048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS160041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical