Provider Demographics
NPI:1861829608
Name:WILCOX, ELIZABETH DIANE ANGOFF (PHD, LEP)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:DIANE ANGOFF
Last Name:WILCOX
Suffix:
Gender:F
Credentials:PHD, LEP
Other - Prefix:DR
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:ANGOFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LEP
Mailing Address - Street 1:954 RISA RD STE A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3418
Mailing Address - Country:US
Mailing Address - Phone:510-423-3329
Mailing Address - Fax:
Practice Address - Street 1:954 RISA RD STE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3418
Practice Address - Country:US
Practice Address - Phone:510-423-3329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-10
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP3115103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist