Provider Demographics
NPI:1679206320
Name:WILSON, MONICA SYMONE
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:SYMONE
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 1:3413 ROSEHEDGE DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1625
Mailing Address - Country:US
Mailing Address - Phone:562-650-4244
Mailing Address - Fax:
Practice Address - Street 1:701 W KIMBERLY AVE STE 125
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6346
Practice Address - Country:US
Practice Address - Phone:714-203-6595
Practice Address - Fax:714-716-4433
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician