Provider Demographics
NPI:1497181408
Name:WILSON, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:SC
Mailing Address - Zip Code:29693-1541
Mailing Address - Country:US
Mailing Address - Phone:864-886-4520
Mailing Address - Fax:
Practice Address - Street 1:206 HAMILTON DR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:SC
Practice Address - Zip Code:29693-1541
Practice Address - Country:US
Practice Address - Phone:864-886-4520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator