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General NPI Number Information
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NPI Number | 1598188286
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Entity Type | Individual
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Provider Name | DWYLA WILSON LPC-S, NCC
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Gender | Female
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 5842 MOHAWK RD
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City | MERIDIAN
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State | MS
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Zip | 39305-1367
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Country | US
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Telephone | 601-693-1234
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Fax | 601-693-1312
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Provider Business Mailing Address
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Address Line | 5842 MOHAWK RD
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City | MERIDIAN
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State | MS
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Zip | 39305-1367
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Country | US
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Telephone | 601-693-1234
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Fax | 601-693-1312
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 246433
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 120
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1578
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License Number State | MS
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