Healthcare Provider Details

I. General information

NPI: 1972275659
Provider Name (Legal Business Name): DEVIN NICHOLE LOVE WILSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11705 ALAMEDA ST
LYNWOOD CA
90262-4023
US

IV. Provider business mailing address

11705 ALAMEDA ST
LYNWOOD CA
90262-4023
US

V. Phone/Fax

Practice location:
  • Phone: 213-473-6100
  • Fax:
Mailing address:
  • Phone: 213-473-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: