Provider Demographics
NPI:1386357739
Name:WILSON, JOCELYN NICOLE (SUDRC 14271)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:NICOLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:SUDRC 14271
Other - Prefix:MRS
Other - First Name:JOCELYN
Other - Middle Name:NICOLE
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 5070
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205
Mailing Address - Country:US
Mailing Address - Phone:209-870-6500
Mailing Address - Fax:209-337-2107
Practice Address - Street 1:1981 CHEROKEE RD.
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205
Practice Address - Country:US
Practice Address - Phone:209-870-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-30
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39007BNA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)