Provider Demographics
NPI:1881863843
Name:WILSON, VALESKA LEI-LANA (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:VALESKA
Middle Name:LEI-LANA
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 195584
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32719-5584
Mailing Address - Country:US
Mailing Address - Phone:407-963-5923
Mailing Address - Fax:
Practice Address - Street 1:12051 CORPORATE BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-1450
Practice Address - Country:US
Practice Address - Phone:407-963-5923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5838101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health