Provider Demographics
NPI:1447269949
Name:ASADA WILKINSON, CAROL
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:ASADA WILKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:ASADA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:12625 HIGH BLUFF DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2052
Mailing Address - Country:US
Mailing Address - Phone:858-792-8300
Mailing Address - Fax:858-408-2494
Practice Address - Street 1:12625 HIGH BLUFF DR
Practice Address - Street 2:SUITE 215
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2052
Practice Address - Country:US
Practice Address - Phone:858-792-8300
Practice Address - Fax:858-408-2494
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11669103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP11669OtherMEDICARE
CAOPL116690OtherBLUE SHIELD PROVIDER#
CA11699155OtherCAQH PROVIDER
CAOPL116690OtherBLUE SHIELD PROVIDER#