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General NPI Number Information
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NPI Number | 1851174650
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Entity Type | Individual
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Provider Name | KAITLYN NICHOLE WILSON LPCC 14444
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Gender | Female
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Dates
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Enumeration Date | 08/15/2023
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 5920 FRIARS RD STE 208
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City | SAN DIEGO
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State | CA
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Zip | 92108-1078
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Country | US
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Telephone | 858-215-2074
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Fax |
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Provider Business Mailing Address
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Address Line | 5920 FRIARS RD STE 208
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City | SAN DIEGO
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State | CA
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Zip | 92108-1078
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Country | US
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Telephone | 540-229-0204
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 14444
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License Number State | CA
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