Provider Demographics
NPI:1134488711
Name:WILSON, CHERYL C (LPCMH)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:C
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 BRANDYWINE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-3242
Mailing Address - Country:US
Mailing Address - Phone:302-761-9800
Mailing Address - Fax:302-761-9800
Practice Address - Street 1:314 BRANDYWINE BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-3242
Practice Address - Country:US
Practice Address - Phone:302-761-9800
Practice Address - Fax:302-761-9800
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000590101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health