Individual
MISS ANDRENIQUE L. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12501 CHANDLER BLVD STE 102, VALLEY VILLAGE, CA 91607-1955
(424) 262-8039
Mailing address
1415 E 110TH ST, LOS ANGELES, CA 90059-1123
(323) 404-0997
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
132269
CA
106H00000X
Marriage & Family Therapist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
02/09/2022
Last updated
05/18/2024
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