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General NPI Number Information
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NPI Number | 1730486770
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Entity Type | Individual
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Provider Name | PAULA MARIE WILSON LPC
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Gender | Female
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Dates
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Enumeration Date | 02/25/2011
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 3722 S STRAITS HWY
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City | INDIAN RIVER
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State | MI
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Zip | 49749-5117
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Country | US
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Telephone | 231-622-3323
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Fax | 231-681-1004
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Provider Business Mailing Address
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Address Line | 8378 DEKRUIF RD
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City | LEVERING
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State | MI
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Zip | 49755-9740
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Country | US
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Telephone | 231-622-3323
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Fax | 231-681-1004
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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 | 6401010902
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License Number State | MI
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