Clarence Carl Wilson, DBH, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2784 Issued in CA

Practice address

851 S Mount Vernon Ave Ste 7a
Colton, CA 92324-3926

Phone

(760) 241-6044

Fax

(760) 820-2704

NPI assigned

Nov 16, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Other names 1

• Dr. Carl Wilson Professional name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Covenant Counseling

  • Community/Behavioral Health Agency
  • Colton, CA
  • NPI 1164967527

  Mental Health

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1033496245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "851 S MOUNT VERNON AVE STE 7A",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923243926",
            "telephone_number": "760-241-6044",
            "fax_number": "760-820-2704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 S MOUNT VERNON AVE STE 7A",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923243926",
            "telephone_number": "760-241-6044",
            "fax_number": "760-820-2704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CLARENCE",
        "middle_name": "CARL",
        "name_prefix": "Dr.",
        "credential": "DBH, LPCC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-11-16",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "RA8320316",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "074006",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MO",
            "license": "2011031159",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "2784",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "2784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARL",
            "last_name": "WILSON",
            "prefix": "DR.",
            "credential": "DBH, LPCC, CADC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Jeffrey Randall Wirth, MFT
• Allison Lynn Wisniewski, D.O
• Kayla Marie Witcik, PA-C
• Alston Yip Wong
• David T Wong, MD

• Mental Health Counselor in Colton, CA
• Providers in Colton, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.