Provider Demographics
NPI:1508446766
Name:WILSON, PETER (MS)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 A ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4105
Mailing Address - Country:US
Mailing Address - Phone:510-459-1761
Mailing Address - Fax:
Practice Address - Street 1:1061 A ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4105
Practice Address - Country:US
Practice Address - Phone:510-459-1761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health