Provider Demographics
NPI:1558441667
Name:WILSON, CATHERINE MARIE
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:MARIE
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 1:1042 SKARDON ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-6072
Mailing Address - Country:US
Mailing Address - Phone:803-481-5420
Mailing Address - Fax:803-481-5420
Practice Address - Street 1:1800 COLONIAL DR
Practice Address - Street 2:COTTAGE A - DEAF SERVICES UNIT
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6827
Practice Address - Country:US
Practice Address - Phone:803-898-2025
Practice Address - Fax:803-898-2174
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health