| NPI | 1518036862 |
|---|---|
| Former Name | DIANA WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 082956) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 2006005206) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2018-03-17 |