Doctor Name: | CYNTHIA WILSON |
NPI Number: | 1396031407 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, MFTI, AT |
License Number: | |
Business Practice Address: | 955 W Center St 12-b Manteca, CA - 953377300 |
Business Phone Number: | 2098526916 |
Business Fax Number: | |
Mailing Address: | 346 W Viento St, MOUNTAIN HOUSE |
State: | CA |
Postal Code: | 953912064 |
Phone Number: | 7073322349 |
Fax Number: | |
NPI Enumeration Date: | 06/27/2011 |
NPI Last Update Date: | 06/28/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |