Healthcare Provider Details

I. General information

NPI: 1609073808
Provider Name (Legal Business Name): VALERIE JOYCE WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 E AVE K4
LANCASTER CA
93535
US

IV. Provider business mailing address

44206 TAHOE WAY
LANCASTER CA
93536-7562
US

V. Phone/Fax

Practice location:
  • Phone: 661-726-5500
  • Fax: 661-726-5502
Mailing address:
  • Phone: 661-943-3172
  • Fax: 661-943-3172

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: