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General NPI Number Information
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NPI Number | 1972436426
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Entity Type | Individual
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Provider Name | DYMOND ALEXIS WILSON
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Gender | Female
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Dates
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Enumeration Date | 06/04/2026
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Last Update Date | 06/04/2026
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Provider Practice Location Address
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Address Line | 5995 PATERNOSTER LN
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City | HUGHESVILLE
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State | MD
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Zip | 20637-3138
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Country | US
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Telephone | 301-535-7604
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Fax | 301-535-7604
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Provider Business Mailing Address
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Address Line | 11530 SULPHUR HILLS PL E
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City | WHITE PLAINS
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State | MD
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Zip | 20695-4117
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Country | US
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Telephone | 301-535-7604
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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