Provider Demographics
NPI:1972733871
Name:WILSON, DIANE M (MFT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 FRANKLIN ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-0400
Mailing Address - Country:US
Mailing Address - Phone:415-440-1243
Mailing Address - Fax:415-564-5890
Practice Address - Street 1:1526 FRANKLIN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-0400
Practice Address - Country:US
Practice Address - Phone:415-440-1243
Practice Address - Fax:415-564-5890
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-26
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33869106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist