Provider Demographics
NPI:1760064323
Name:WILSON, ASHLEE S (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEE
Middle Name:S
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 CALLE DECEO
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3345
Mailing Address - Country:US
Mailing Address - Phone:763-245-0390
Mailing Address - Fax:
Practice Address - Street 1:1079 CALLE DECEO
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-3345
Practice Address - Country:US
Practice Address - Phone:763-245-0390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9545103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling