Provider Demographics
NPI:1790910867
Name:WILSON, DARRAH (MS, MFTI)
Entity Type:Individual
Prefix:MRS
First Name:DARRAH
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS, MFTI
Other - Prefix:
Other - First Name:DARRAH
Other - Middle Name:
Other - Last Name:MELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:480 E. 13TH STREET
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341
Mailing Address - Country:US
Mailing Address - Phone:209-381-6800
Mailing Address - Fax:
Practice Address - Street 1:1170 W OLIVE AVE
Practice Address - Street 2:G
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-1959
Practice Address - Country:US
Practice Address - Phone:209-725-2125
Practice Address - Fax:209-384-1495
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA76312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health