| Doctor Name: | DIANA ROSE WILSON-SIMKINS |
| NPI Number: | 1801255146 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CATC |
| License Number: | W1402281344 |
| Business Practice Address: | 3937 Foothill Dr Lucerne, CA - 95458 |
| Business Phone Number: | 7072748171 |
| Business Fax Number: | |
| Mailing Address: | Po Box 316, LUCERNE |
| State: | CA |
| Postal Code: | 954580316 |
| Phone Number: | 7072748171 |
| Fax Number: | |
| NPI Enumeration Date: | 02/15/2016 |
| NPI Last Update Date: | 02/15/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | W1402281344 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |