Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1033793559 |
---|---|
Provider Name | Denise Wilson |
First Address | Fairfax, VA 22031-4513 |
Second Address | Fairfax, VA 22031-4513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2021 |
Last Update Date | 11/05/2021 |