Provider Demographics
NPI:1295867281
Name:WILSON, V. SAUNDRA (MFTI)
Entity Type:Individual
Prefix:MS
First Name:V.
Middle Name:SAUNDRA
Last Name:WILSON
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12714 AVALON BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90061-2730
Mailing Address - Country:US
Mailing Address - Phone:323-242-5000
Mailing Address - Fax:323-242-3521
Practice Address - Street 1:12714 AVALON BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90061-2730
Practice Address - Country:US
Practice Address - Phone:323-242-5000
Practice Address - Fax:323-242-3521
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF43323106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist