Individual
DENISE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
717 LINCOLN BLVD, VENICE, CA 90291-2845
(310) 399-9883
Mailing address
26460 SUMMIT CIR, SANTA CLARITA, CA 91350-2991
(661) 254-6630
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
10/14/2008
Last updated
10/14/2008
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