Provider Demographics
NPI:1598465122
Name:WING, TREVOR BRIAN I (MA)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:BRIAN
Last Name:WING
Suffix:I
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25143 JACK RABBIT ACRES
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-1267
Mailing Address - Country:US
Mailing Address - Phone:760-566-8648
Mailing Address - Fax:
Practice Address - Street 1:25143 JACK RABBIT ACRES
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-1267
Practice Address - Country:US
Practice Address - Phone:760-566-8648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health