Individual
HEATHER L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHA
Contact information
Practice address
201 E 2ND ST, TOMPKINSVILLE, KY 42167-1673
(270) 487-5655
(270) 487-5948
Mailing address
575 WITT MARSH RD, GAMALIEL, KY 42140-9533
(270) 901-5000
(270) 842-5268
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30604011
—
KY
Enumeration date
01/31/2007
Last updated
07/08/2007
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