MEDICARE: MS. REGINA WILSON MA CAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1114074143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REGINA WILSON MA CAP

Provider Business Mailing Address
First Line	:	701 LINCOLN RD
Second Line	:	SUITE 200
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-2879
Country	:	US
Telephone Number	:	305-531-5341
Fax Number	:	305-532-5322

Provider Business Practice Location Address
First Line	:	701 LINCOLN RD
Second Line	:	SUITE 200
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-2879
Country	:	US
Telephone Number	:	305-531-5341
Fax Number	:	305-532-5322

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/09/2007

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