Individual
CANDACE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1850 SAN BENITO ST, HOLLISTER, CA 95023
(831) 636-2121
Mailing address
1850 SAN BENITO ST, HOLLISTER, CA 95023-4899
(831) 636-2121
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2018
Last updated
11/05/2019
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