| NPI | 1457033375 |
|---|---|
| Former Name | JESSICA NICOLE WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2023-08-01 |
| Last Update Date | 2023-08-01 |