Provider Demographics
NPI:1073205001
Name:WILSON, BARBARA L (MHT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:WILSON
Suffix:
Gender:F
Credentials:MHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 ADRIAN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-6706
Mailing Address - Country:US
Mailing Address - Phone:662-378-7444
Mailing Address - Fax:
Practice Address - Street 1:522 W PARK AVE STE Q-R
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-2906
Practice Address - Country:US
Practice Address - Phone:662-374-5029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health