Doctor Name: | MS. KIMBERLY WILSON |
NPI Number: | 1245457761 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMFT |
License Number: | MFT19855 |
Business Practice Address: | 6692 Merchandise Way Ste B Diamond Springs, CA - 956199453 |
Business Phone Number: | 5306262589 |
Business Fax Number: | |
Mailing Address: | 2827 Silvercrest St, PLACERVILLE |
State: | CA |
Postal Code: | 956673459 |
Phone Number: | 5306265919 |
Fax Number: | |
NPI Enumeration Date: | 04/18/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MFT19855 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |