Provider Demographics
NPI:1326176934
Name:WILSON, LAURA BETH (MSW; LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSW; LCSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:BETH
Other - Last Name:VILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW; LCSW
Mailing Address - Street 1:10221 COMPTON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WATTS
Mailing Address - State:CA
Mailing Address - Zip Code:90002-2802
Mailing Address - Country:US
Mailing Address - Phone:310-783-4677
Mailing Address - Fax:
Practice Address - Street 1:10221 COMPTON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:WATTS
Practice Address - State:CA
Practice Address - Zip Code:90002-2802
Practice Address - Country:US
Practice Address - Phone:310-783-4677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA266281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical