Individual
AGIA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12021 WILMINGTON AVE, LOS ANGELES, CA 90059-3019
(310) 817-3959
Mailing address
12021 WILMINGTON AVE, LOS ANGELES, CA 90059-3019
(310) 817-3959
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
ASW133371
CA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/28/2023
Last updated
05/05/2026
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