MEDICARE: JANET C. WILSON, PH.D., ABPP, PLLC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1760639215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANET C. WILSON, PH.D., ABPP, PLLC

Provider Business Mailing Address
First Line	:	617 S TAYLOR ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-1448
Country	:	US
Telephone Number	:	703-521-1127
Fax Number	:	703-348-3548

Provider Business Practice Location Address
First Line	:	617 S TAYLOR ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-1448
Country	:	US
Telephone Number	:	703-521-1127
Fax Number	:	703-348-3548

Authorized Official
Title or Position	:	LICENSED CLINICAL PSYCHOLOGIST
Name	:	DR. JANET CAROL WILSON
Credential	:	PH.D.
Telephone Number	:	703-521-1127

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	08/26/2008

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