Provider Demographics
NPI:1811615545
Name:WILSON, CHRISTIAN FAITH
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:FAITH
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-4046
Mailing Address - Country:US
Mailing Address - Phone:619-880-0455
Mailing Address - Fax:
Practice Address - Street 1:134 PARK BLVD
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4046
Practice Address - Country:US
Practice Address - Phone:619-880-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor