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General NPI Number Information
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NPI Number | 1912569609
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Entity Type | Individual
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Provider Name | SANDRA LYNN WILSON LMFT
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Gender | Female
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Dates
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Enumeration Date | 07/02/2019
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 2677 N MAIN ST STE 130
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City | SANTA ANA
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State | CA
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Zip | 92705-6665
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Country | US
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Telephone | 714-274-7577
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 442
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City | PLACENTIA
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State | CA
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Zip | 92871-0442
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Country | US
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Telephone | 562-237-8879
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 112689
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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 | 131566
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License Number State | CA
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