Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1235388323 |
---|---|
Provider Name | Ms. Roshanya Thenean Wilcox |
First Address | Indiantown, FL 34956-1520 |
Second Address | Indiantown, FL 34956-3513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2008 |
Last Update Date | 12/09/2008 |