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NPI Code Detail

MEDICARE: MS. SALLY W WILSON LMFT,CAC

MEDICARE: MS. SALLY W WILSON LMFT,CAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMF 000040PA
2101YA0400XAddiction (Substance Use Disorder) Counselor2828PA

General Provider Information

NPI Number : 1316196058
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SALLY W WILSON LMFT,CAC
Provider Business Mailing Address
First Line : 225 S CHURCH ST
Second Line :
City : WEST CHESTER
State : PA
Zip : 19382-3386
Country : US
Telephone Number : 610-436-0125
Fax Number :
Provider Business Practice Location Address
First Line : 225 S CHURCH ST
Second Line :
City : WEST CHESTER
State : PA
Zip : 19382-3386
Country : US
Telephone Number : 610-436-0125
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2008
Last Update Date : 09/18/2008

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