Doctor Name: | MRS. RHONDA WILSON |
NPI Number: | 1013392299 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC-MHSP |
License Number: | 3411 |
Business Practice Address: | 5516 Barons Point Ooltewah, TN - 37363 |
Business Phone Number: | 4233643604 |
Business Fax Number: | |
Mailing Address: | 5516 Barons Pt, OOLTEWAH |
State: | TN |
Postal Code: | 373638875 |
Phone Number: | 4233643604 |
Fax Number: | |
NPI Enumeration Date: | 07/29/2015 |
NPI Last Update Date: | 07/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 3411 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |