| NPI | 1164967527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARENCE CARL WILSON Director 760-241-6044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: CA LPCC2784) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2016-12-21 |
| Last Update Date | 2021-05-18 |