Provider Demographics
NPI:1497846158
Name:WILSON, JANET C (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:C
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 S TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1448
Mailing Address - Country:US
Mailing Address - Phone:703-521-1127
Mailing Address - Fax:703-521-1127
Practice Address - Street 1:617 S TAYLOR ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1448
Practice Address - Country:US
Practice Address - Phone:703-521-1127
Practice Address - Fax:703-521-1127
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA081001708103TC0700X
VA0810001708103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA491879Medicare ID - Type Unspecified