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General NPI Number Information
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NPI Number | 1134711377
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Entity Type | Individual
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Provider Name | DREW V WILSON LMFT
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Gender | Male
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Dates
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Enumeration Date | 02/09/2021
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 11600 ELDRIDGE AVE
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City | LAKE VIEW TERRACE
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State | CA
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Zip | 91342-6506
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Country | US
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Telephone | 661-233-5504
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Fax |
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Provider Business Mailing Address
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Address Line | 11600 ELDRIDGE AVE
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City | LAKE VIEW TERRACE
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State | CA
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Zip | 91342-6506
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Country | US
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Telephone | 661-233-5504
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 14448-RAC
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT131280
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 151069
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License Number State | CA
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