Individual
ADA D WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
2 BALA PLZ, SUITE 300, BALA CYNWYD, PA 19004-1501
(610) 660-7779
(610) 667-8174
Mailing address
742 B PUTNAM BLVD, APT B, WALLINGFORD, PA 19086
(610) 876-1458
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1025537100001
MA
PA
05
—
1025537100001
—
PA
Enumeration date
09/12/2011
Last updated
09/12/2011
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