Provider Demographics
NPI:1568726925
Name:WILSON, BRIGITTE ILENE
Entity Type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:ILENE
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2241 GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-1134
Mailing Address - Country:US
Mailing Address - Phone:707-258-9030
Mailing Address - Fax:
Practice Address - Street 1:1735 ENTERPRISE DR
Practice Address - Street 2:SUITE 105A
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6822
Practice Address - Country:US
Practice Address - Phone:707-425-1799
Practice Address - Fax:707-425-1081
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-30
Last Update Date:2012-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)