Provider Demographics
NPI:1205970498
Name:WILKINSON, DIANA MARIE (MFT)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:MARIE
Last Name:WILKINSON
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 1:2712 CUMBERLAND PL
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-2909
Mailing Address - Country:US
Mailing Address - Phone:530-758-5913
Mailing Address - Fax:530-758-5913
Practice Address - Street 1:163 2ND ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3316
Practice Address - Country:US
Practice Address - Phone:530-867-2626
Practice Address - Fax:530-688-9194
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28814106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist