Individual
DR. CLARENCE ELWOOD WILSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
14901 CENTRAL AVE, CHINO, CA 91710-9500
(909) 597-1821
Mailing address
8816 FOOTHILL BLVD STE 103, RANCHO CUCAMONGA, CA 91730-7199
(909) 597-1821
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY 15219
CA
Other
Enumeration date
12/21/2011
Last updated
12/21/2011
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