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NPI Code Detail

MEDICARE: CHRISTINE WILSON LMHC

MEDICARE: CHRISTINE WILSON LMHC
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
1101YM0800XMental Health CounselorMH8926FL

General Provider Information

NPI Number : 1962605717
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE WILSON LMHC
Provider Business Mailing Address
First Line : 64 BLACK BASS BLVD
Second Line :
City : DEFUNIAK SPRINGS
State : FL
Zip : 32433-8522
Country : US
Telephone Number : 850-333-0813
Fax Number : 850-333-0813
Provider Business Practice Location Address
First Line : 5642 JONES ST
Second Line :
City : MILTON
State : FL
Zip : 32570-2304
Country : US
Telephone Number : 850-626-7779
Fax Number : 850-626-7171
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2007
Last Update Date : 01/09/2014

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Directions to “ CHRISTINE WILSON LMHC” Practice Location

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