Provider Demographics
NPI:1720659873
Name:WILEY, KIANA EBONY
Entity type:Individual
Prefix:
First Name:KIANA
Middle Name:EBONY
Last Name:WILEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 LANE AVE STE 126
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-3515
Mailing Address - Country:US
Mailing Address - Phone:858-333-6856
Mailing Address - Fax:
Practice Address - Street 1:900 LANE AVE STE 126
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3515
Practice Address - Country:US
Practice Address - Phone:858-333-6856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA154281106H00000X
CA106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health