Healthcare Provider Details

I. General information

NPI: 1649976150
Provider Name (Legal Business Name): VIRGINIA WESSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PRIMACY PKWY
MEMPHIS TN
38119-0213
US

IV. Provider business mailing address

1350 CONCOURSE AVE APT 857
MEMPHIS TN
38104-2045
US

V. Phone/Fax

Practice location:
  • Phone: 901-866-8812
  • Fax:
Mailing address:
  • Phone: 205-451-7784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: