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General NPI Number Information
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NPI Number | 1871418103
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Entity Type | Individual
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Provider Name | J DEREK WILSON MAPC, DMIN
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Gender | Male
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Dates
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Enumeration Date | 08/13/2026
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Last Update Date | 08/13/2026
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Provider Practice Location Address
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Address Line | 351 NEW RIVER RANCH DR
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City | FAYETTEVILLE
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State | WV
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Zip | 25840-6220
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Country | US
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Telephone | 304-574-1058
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Fax |
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Provider Business Mailing Address
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Address Line | 463 WHITLOW RD
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City | PRINCETON
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State | WV
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Zip | 24739-4786
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Country | US
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Telephone |
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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 | WV
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