Healthcare Provider Details

I. General information

NPI: 1891396206
Provider Name (Legal Business Name): MS. ADRIENNA DENISE WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 W BASELINE RD STE 116
PHOENIX AZ
85041-6400
US

IV. Provider business mailing address

6325 W MOHAVE ST
PHOENIX AZ
85043-5734
US

V. Phone/Fax

Practice location:
  • Phone: 602-899-2534
  • Fax:
Mailing address:
  • Phone: 602-206-5762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: