Provider Demographics
NPI:1538207931
Name:WILSON, AUBURN III
Entity type:Individual
Prefix:MR
First Name:AUBURN
Middle Name:
Last Name:WILSON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 QUAIL LAKES DR
Mailing Address - Street 2:G 206
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5267
Mailing Address - Country:US
Mailing Address - Phone:916-854-1801
Mailing Address - Fax:916-854-1809
Practice Address - Street 1:3077 FITE CIR
Practice Address - Street 2:SUITE 6
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-1814
Practice Address - Country:US
Practice Address - Phone:916-854-1801
Practice Address - Fax:916-854-1809
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health