Individual
MR. CARL GIOVANNI WILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1801 FOX DR, CHAMPAIGN, IL 61820-7236
(217) 359-5276
Mailing address
1709 W NELSON ST, CHICAGO, IL 60657-3028
(773) 988-7462
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
—
—
103TC1900X
Counseling Psychologist
Primary
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
Other
Enumeration date
11/05/2009
Last updated
11/05/2009
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