Provider Demographics
NPI:1770892291
Name:WILSON, SARANNE J (LMFT)
Entity type:Individual
Prefix:
First Name:SARANNE
Middle Name:J
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SPRING STREET
Mailing Address - Street 2:#307
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-328-1343
Mailing Address - Fax:619-328-1354
Practice Address - Street 1:4700 SPRING STREET #307
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-328-1343
Practice Address - Fax:619-328-1354
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40383106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist