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Individual

MRS. JILL ANNE RUBIN WISHART

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW DCSW

Contact information

Practice address
26 MIDWAY ST, BRISTOL REGIONAL COUNSELING CENTER, BRISTOL, TN 37620
(423) 989-4500
(423) 989-4582
Mailing address
PO BOX 9054, GRAY, TN 37615-9054
(423) 467-3600
(423) 467-3696

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
0904003737
VA
104100000X
Social Worker
Primary
LSW0000003204
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
099634
VALUEOPTIONS
01
1051419
CIGNA MCC
01
253893
ANTHEM PROF TRIGON
01
3048466
MAGELLAN SUMMIT
01
334969
VALUEOPTIONS GROUP
01
39725
UBH JOHN DEERE
Enumeration date
09/12/2006
Last updated
07/08/2007
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