MEDICARE: DEVIN NICHOLE LOVE WILSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1972275659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVIN NICHOLE LOVE WILSON LCSW

Provider Business Mailing Address
First Line	:	11705 ALAMEDA ST
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-4023
Country	:	US
Telephone Number	:	213-473-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	11705 ALAMEDA ST
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-4023
Country	:	US
Telephone Number	:	213-473-6100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2021
Last Update Date	:	12/12/2025

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