Most Relevant Information
Provider Data
| NPI Number: | 1003472739 |
| Provider Name: | JUSTIN WILSON CCAPP CERTIFIED |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/17/2019 |
| Last Updated: | 05/17/2019 |
Provider Practice Location
3125 E 7TH ST
LONG BEACH
CA
908044932
Practice Location Phone/Fax
| Phone: | 5629875722 |
| Fax: | 5629874586 |
Provider Mailing Location
1041 REDONDO AVE
LONG BEACH
CA
908043928
Provider Mailing Phone/Fax
| Phone: | 5629875722 |
| Fax: | 5629874586 |