Provider Demographics
NPI:1013262211
Name:DURAN-WILSON, JUANITA (LCSW, ATR-BC)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:DURAN-WILSON
Suffix:
Gender:F
Credentials:LCSW, ATR-BC
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 203
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95518-0203
Mailing Address - Country:US
Mailing Address - Phone:707-601-8311
Mailing Address - Fax:
Practice Address - Street 1:930 W HARRIS ST
Practice Address - Street 2:EUREKA VA CBOC
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-3927
Practice Address - Country:US
Practice Address - Phone:707-269-2825
Practice Address - Fax:707-269-7556
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA279721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical