Provider Demographics
NPI:1548418478
Name:WILSON, ANTHONY R
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:R
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 STONECREST ROAD
Mailing Address - Street 2:
Mailing Address - City:BLAKESLEE
Mailing Address - State:PA
Mailing Address - Zip Code:18610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:492 ROUTE 57 WEST
Practice Address - Street 2:FAMILY GUIDANCE CENTER OF WARREN COUNTY
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882
Practice Address - Country:US
Practice Address - Phone:908-689-1000
Practice Address - Fax:908-689-4529
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health