Provider Demographics
NPI:1023464385
Name:WILKINSON RELLA, LORI (MA, LMFT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:WILKINSON RELLA
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 MANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1729
Mailing Address - Country:US
Mailing Address - Phone:408-737-1023
Mailing Address - Fax:
Practice Address - Street 1:1585 THE ALAMEDA
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2310
Practice Address - Country:US
Practice Address - Phone:408-757-0656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90194106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist