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General NPI Number Information
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NPI Number | 1952089682
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Entity Type | Individual
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Provider Name | LUCINDA ANN WILSON L.M.F.T. #51054
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Gender | Female
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 23282 MILL CREEK DR
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1658
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Country | US
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Telephone | 714-875-0707
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Fax |
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Provider Business Mailing Address
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Address Line | 350 FOREST AVE UNIT 1114
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City | LAGUNA BEACH
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State | CA
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Zip | 92652-2048
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Country | US
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Telephone |
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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 | 51054
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License Number State | CA
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