Basic Information
| Provider Information | |||||||||
| NPI: | 1609073808 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | VALERIE | ||||||||
| MiddleName: | JOYCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44206 TAHOE WAY | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935367562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619433172 | ||||||||
| FaxNumber: | 6619433172 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 E AVE K4 | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617265500 | ||||||||
| FaxNumber: | 6617265502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.