Provider Demographics
NPI:1902164643
Name:ANITA LYNN WILSON
Entity Type:Organization
Organization Name:ANITA LYNN WILSON
Other - Org Name:ABA AND VB GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE AND CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:619-281-6067
Mailing Address - Street 1:3245 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 1-334
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2009
Mailing Address - Country:US
Mailing Address - Phone:619-281-6067
Mailing Address - Fax:
Practice Address - Street 1:4455 MURPHY CANYON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4379
Practice Address - Country:US
Practice Address - Phone:619-281-6067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-00-0302103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty