| Doctor Name: | NADINE ANITA WILSON |
| NPI Number: | 1235336470 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BS |
| License Number: | |
| Business Practice Address: | 3407 Shamrock Ct Gautier, MS - 39553 |
| Business Phone Number: | 2284970690 |
| Business Fax Number: | 2284971363 |
| Mailing Address: | 3407 Shamrock Ct, GAUTIER |
| State: | MS |
| Postal Code: | 39553 |
| Phone Number: | 2284970690 |
| Fax Number: | 2284971363 |
| NPI Enumeration Date: | 06/29/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |