Individual
CAROLYN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
4519 GREENFIELD DR, COOKEVILLE, TN 38501-9480
(931) 261-0889
Mailing address
4519 GREENFIELD DR, COOKEVILLE, TN 38501-9480
(931) 261-0889
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
18-32323
TN
103K00000X
Behavior Analyst
Primary
18-32323
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-17-32048
BACB
—
Enumeration date
05/16/2018
Last updated
05/06/2019
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