Provider Demographics
NPI:1548770829
Name:WILSON, HERMAN CHARLES JR (BS)
Entity Type:Individual
Prefix:MR
First Name:HERMAN
Middle Name:CHARLES
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3125 RIDGE PIKE
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-5708
Mailing Address - Country:US
Mailing Address - Phone:610-630-2111
Mailing Address - Fax:610-630-4003
Practice Address - Street 1:3125 RIDGE PIKE
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-5708
Practice Address - Country:US
Practice Address - Phone:610-630-2111
Practice Address - Fax:610-630-4003
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker