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NPI Code Detail

MEDICARE: MS. GAIL WILSON MS

MEDICARE: MS. GAIL WILSON MS
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
1101YM0800XMental Health CounselorIMH25063FL
2104100000XSocial Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1IMH25063OTHERFLFLORIDA DEPARTMENT OF HEALTH: REGISTERED MENTAL HEALTH COUNSELOR INTERN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356514723
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. GAIL WILSON MS
Provider Business Mailing Address
First Line : PO BOX 174
Second Line :
City : EAST PALATKA
State : FL
Zip : 32131-0174
Country : US
Telephone Number : 386-916-1818
Fax Number :
Provider Business Practice Location Address
First Line : 6625 ARGYLE FOREST BLVD STE 4, #1174
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32244-6126
Country : US
Telephone Number : 904-780-9827
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2008
Last Update Date : 10/19/2024

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