Doctor Name: | JUANITA DURAN WILSON |
NPI Number: | 1013262211 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW, ATR-BC |
License Number: | 27972 |
Business Practice Address: | 930 W Harris St Eureka Va Cboc Eureka, CA - 955033927 |
Business Phone Number: | 7072697500 |
Business Fax Number: | |
Mailing Address: | Po Box 203, ARCATA |
State: | CA |
Postal Code: | 955180203 |
Phone Number: | 7076018311 |
Fax Number: | |
NPI Enumeration Date: | 07/13/2012 |
NPI Last Update Date: | 05/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 27972 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |