| Doctor Name: | MS. TERRA RENNE WILSON |
| NPI Number: | 1821134271 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | SAC II |
| License Number: | |
| Business Practice Address: | 9345 Winchester Lower Lake, CA - 95457 |
| Business Phone Number: | 7079953235 |
| Business Fax Number: | 7079957004 |
| Mailing Address: | 9345 Winchester, LOWER LAKE |
| State: | CA |
| Postal Code: | 954575720 |
| Phone Number: | 7079953235 |
| Fax Number: | 7079957004 |
| NPI Enumeration Date: | 01/30/2007 |
| NPI Last Update Date: | 08/21/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |