Wayne Wilson Licensed Clinical Social Worker Inc.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

WAYNE WILSON LICENSED CLINICAL SOCIAL WORKER INC.

Practice address

605 Town Center Dr.
Costa Mesa, CA 92626

Phone

(949) 949-0009

NPI assigned

Apr 23, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Katelyn Dungo

Title

Human Resources

Phone

(208) 869-8386

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1745366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745366400000",
    "number": "1457148405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 TOWN CENTER DR.",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "92626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 TOWN CENTER DR.",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "92626",
            "telephone_number": "949-949-0009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE WILSON LICENSED CLINICAL SOCIAL WORKER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-23",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-15",
        "status": "A",
        "authorized_official_last_name": "DUNGO",
        "authorized_official_first_name": "KATELYN",
        "authorized_official_title_or_position": "HUMAN RESOURCES",
        "authorized_official_telephone_number": "208-869-8386"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.