Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 104100000X | Social Worker |
NPI | 1003251695 |
---|---|
Provider Name | Mrs. Terri Anika Wilson |
First Address | Ewa Beach, HI 96706-5113 |
Second Address | Ewa Beach, HI 96706-5113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2013 |
Last Update Date | 09/11/2020 |