Individual
JAMIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLP
Contact information
Practice address
5001 PLAINFIELD AVE NE STE B, GRAND RAPIDS, MI 49525-1050
(616) 600-1667
Mailing address
5001 PLAINFIELD AVE NE STE B, GRAND RAPIDS, MI 49525-1050
(616) 600-1667
(616) 805-3613
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6301015678
MI
103T00000X
Psychologist
6301015678
MI
103T00000X
Psychologist
6361004924
MI
103TA0700X
Adult Development & Aging Psychologist
6301015678
MI
103TC1900X
Counseling Psychologist
6301015678
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770913832
—
MI
Enumeration date
11/26/2013
Last updated
09/18/2022
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