Provider Demographics
NPI:1558097931
Name:WILSON, CATHERINE ADELA (MED)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ADELA
Last Name:WILSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3140
Mailing Address - Country:US
Mailing Address - Phone:609-626-4343
Mailing Address - Fax:
Practice Address - Street 1:375 MORGAN ST
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-3588
Practice Address - Country:US
Practice Address - Phone:215-558-8895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional