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General NPI Number Information
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NPI Number | 1205345105
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Entity Type | Organization
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Legal Business Name | BILL WILSON CENTER
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Dates
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Enumeration Date | 09/22/2017
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 591 N KING RD STE 1
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City | SAN JOSE
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State | CA
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Zip | 95133-1661
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Country | US
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Telephone | 408-278-2530
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 127
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City | NAPA
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State | CA
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Zip | 94559-0127
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Country | US
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Telephone | 707-255-3300
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Fax | 707-255-3527
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Authorized Official
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Title or Position | DIVISION DIRECTOR
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Name | PAMELAH STEPHENS
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Credential |
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Telephone | 408-278-2530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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