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General NPI Number Information
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NPI Number | 1730461153
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Entity Type | Individual
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Provider Name | ADA D WILSON BA
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Gender | Female
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Dates
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Enumeration Date | 09/12/2011
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 2 BALA PLZ SUITE 300
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1501
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Country | US
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Telephone | 610-660-7779
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Fax | 610-667-8174
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Provider Business Mailing Address
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Address Line | 742 B PUTNAM BLVD APT B
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City | WALLINGFORD
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State | PA
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Zip | 19086
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Country | US
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Telephone | 610-876-1458
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Fax |
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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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 |
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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