Provider Demographics
NPI:1447481171
Name:WILSON, CATHERINE MARY
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:MARY
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-2621
Mailing Address - Country:US
Mailing Address - Phone:323-268-5442
Mailing Address - Fax:323-268-0844
Practice Address - Street 1:501 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-2621
Practice Address - Country:US
Practice Address - Phone:323-268-5442
Practice Address - Fax:323-268-0844
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)