MEDICARE: QUNIQUE WILSON

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1790223600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUNIQUE WILSON

Provider Business Mailing Address
First Line	:	4719 SEA OATS CIR
Second Line	:	301
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-8037
Country	:	US
Telephone Number	:	434-806-4627
Fax Number	:

Provider Business Practice Location Address
First Line	:	4719 SEA OATS CIR
Second Line	:	301
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-8037
Country	:	US
Telephone Number	:	434-806-4627
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2017
Last Update Date	:	02/10/2017

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