Provider Demographics
NPI:1851858575
Name:WILSON, NANCY (CADC-II)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 HARBOR BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-8518
Mailing Address - Country:US
Mailing Address - Phone:888-418-4188
Mailing Address - Fax:
Practice Address - Street 1:2001 HARBOR BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-8518
Practice Address - Country:US
Practice Address - Phone:888-418-4188
Practice Address - Fax:949-209-0369
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA018330415101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)