Provider Demographics
NPI:1053348334
Name:WACTER, ALISON (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:
Last Name:WACTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:WIEDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2347 TERRAZA GUITARA
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-6624
Mailing Address - Country:US
Mailing Address - Phone:858-279-1223
Mailing Address - Fax:858-509-4789
Practice Address - Street 1:505 LOMAS SANTA FE DR
Practice Address - Street 2:SUITE 260
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1333
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:858-509-4789
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18950103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical