Provider Demographics
NPI:1578219069
Name:WYATT, ZOINTRIKCA TWYSHAWN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:ZOINTRIKCA
Middle Name:TWYSHAWN
Last Name:WYATT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 SANTA MONICA BLVD STE 8
Mailing Address - Street 2:#1117
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2480
Mailing Address - Country:US
Mailing Address - Phone:312-513-4424
Mailing Address - Fax:
Practice Address - Street 1:3002 ARMSTRONG ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-5702
Practice Address - Country:US
Practice Address - Phone:858-277-9550
Practice Address - Fax:858-571-4544
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145568106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist