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General NPI Number Information
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NPI Number | 1679241186
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Entity Type | Individual
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Provider Name | VICTORIA ANN WILSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 05/06/2023
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Provider Practice Location Address
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Address Line | 1350 S MILFORD RD
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City | HIGHLAND
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State | MI
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Zip | 48357-4858
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Country | US
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Telephone | 810-410-7053
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Fax | 248-499-1232
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Provider Business Mailing Address
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Address Line | 7846 MEADOW DR
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City | WATERFORD
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State | MI
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Zip | 48329-4613
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Country | US
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Telephone | 248-854-1422
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Fax | 248-690-2410
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801066196
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License Number State | MI
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