Individual
DEITRA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
24100 CHARGIN BLVD, SUITE 250, BEACHWOOD, OH 44122
(440) 343-8069
(440) 264-1990
Mailing address
24100 CHARGIN BLVD, SUITE 250, BEACHWOOD, OH 44122
(440) 343-8069
(440) 264-1990
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C.2406416-TRNE
OH
Other
Enumeration date
01/16/2025
Last updated
01/16/2025
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