Healthcare Provider Details

I. General information

NPI: 1689510554
Provider Name (Legal Business Name): JULIE B WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 ACHESON AVE
WASHINGTON PA
15301-6301
US

IV. Provider business mailing address

49 ACHESON AVE
WASHINGTON PA
15301-6301
US

V. Phone/Fax

Practice location:
  • Phone: 724-747-3148
  • Fax:
Mailing address:
  • Phone: 724-747-3148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC002219
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: