Active NPI
Carleon Christos Wilson
- Professional Counselor
- Colton, CA
National Provider Identifier
1578298279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- Practice address
- 851 S Mount Vernon Ave Ste 7a
Colton, CA 92324-3926 - Phone
- (760) 241-6044
- Fax
- (909) 639-7079
- NPI assigned
- Jul 18, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Pastoral Counselor | 101YP1600X | |||
| Marriage & Family Therapist | 106H00000X | |||
| Professional Counselor | 101YP2500X | Primary |
Addresses
Primary practice location
851 S Mount Vernon Ave Ste 7a
Colton, CA 92324-3926
Mailing address
851 S Mount Vernon Ave Ste 7a
Colton, CA 92324-3926
Phone (760) 241-6044
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Covenant Counseling | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658102400000",
"number": "1578298279",
"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": "909-639-7079"
},
{
"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": "909-639-7079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CARLEON",
"middle_name": "CHRISTOS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-07-18",
"last_updated": "2022-07-18",
"certification_date": "2022-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP1600X",
"taxonomy_group": "",
"desc": "Counselor, Pastoral",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.