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General NPI Number Information
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NPI Number | 1932235413
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Entity Type | Individual
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Provider Name | JEANNETTE CHRISTINE WILSON LMFT
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 2308 J ST STE D
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City | SACRAMENTO
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State | CA
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Zip | 95816-4718
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Country | US
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Telephone | 916-572-7236
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 221534
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City | SACRAMENTO
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State | CA
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Zip | 95822-8534
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Country | US
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Telephone | 916-519-8977
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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 | 101Y00000X
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Taxonomy Name | 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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