Provider Demographics
NPI:1053780841
Name:WORDEN, AMERICA (MFT)
Entity type:Individual
Prefix:MS
First Name:AMERICA
Middle Name:
Last Name:WORDEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WASHINGTON ST
Mailing Address - Street 2:#9
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 WASHINGTON ST
Practice Address - Street 2:#9
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2315
Practice Address - Country:US
Practice Address - Phone:707-280-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT84774101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor