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General NPI Number Information
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NPI Number | 1386203586
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Entity Type | Organization
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Legal Business Name | BETH WILSON, LLC
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 606 S MARKET ST
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City | SALEM
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State | VA
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Zip | 24153-5012
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Country | US
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Telephone | 423-967-9951
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Fax |
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Provider Business Mailing Address
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Address Line | 606 S MARKET ST
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City | SALEM
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State | VA
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Zip | 24153-5012
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Country | US
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Telephone | 423-967-9951
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALICE SYDNOR
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Credential | LCP
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Telephone | 423-967-9951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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