Provider Demographics
NPI:1881242956
Name:WILSON, KELLY MARGARET (LCSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARGARET
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 GIRD RD
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-9687
Mailing Address - Country:US
Mailing Address - Phone:760-505-0570
Mailing Address - Fax:
Practice Address - Street 1:1667 S MISSION RD STE C
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-4113
Practice Address - Country:US
Practice Address - Phone:760-505-0570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1058031041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical