Healthcare Provider Details

I. General information

NPI: 1699639146
Provider Name (Legal Business Name): MR. JULIUS ELIZAH WILSON-SMALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

686 WEDGEWOOD DR APT 8
COLUMBUS OH
43228-4315
US

IV. Provider business mailing address

686 WEDGEWOOD DR APT 8
COLUMBUS OH
43228-4315
US

V. Phone/Fax

Practice location:
  • Phone: 614-736-9214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: