| Doctor Name: | VANESSA V WILSON |
| NPI Number: | 1073953220 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 5905 Soquel Dr Soquel, CA - 950732855 |
| Business Phone Number: | 8314285426 |
| Business Fax Number: | |
| Mailing Address: | 3645 Gatewood Ct, SANTA CRUZ |
| State: | CA |
| Postal Code: | 950651666 |
| Phone Number: | 8314285426 |
| Fax Number: | |
| NPI Enumeration Date: | 07/02/2013 |
| NPI Last Update Date: | 08/27/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |