Provider Demographics
NPI:1679934657
Name:WILCOX, CIARA LYNISE (LMFT 113121)
Entity Type:Individual
Prefix:
First Name:CIARA
Middle Name:LYNISE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:LMFT 113121
Other - Prefix:
Other - First Name:CIARA
Other - Middle Name:LYNISE
Other - Last Name:BRANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8775 SIERRA COLLEGE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5985
Mailing Address - Country:US
Mailing Address - Phone:916-220-5483
Mailing Address - Fax:916-625-6826
Practice Address - Street 1:8775 SIERRA COLLEGE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-220-5483
Practice Address - Fax:916-625-6826
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113121106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist