Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003006362 |
---|---|
Provider Name | Michele Mabry Wilson |
First Address | Pleasanton, CA 94588-8500 |
Second Address | Oakland, CA 94609-3301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2007 |
Last Update Date | 01/08/2007 |