Provider Demographics
NPI:1598109845
Name:WILSON, SHERI ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHERI
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 JENNINGS MILL DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-7260
Mailing Address - Country:US
Mailing Address - Phone:202-549-8074
Mailing Address - Fax:301-390-8262
Practice Address - Street 1:102 JENNINGS MILL DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-7260
Practice Address - Country:US
Practice Address - Phone:202-549-8074
Practice Address - Fax:301-390-8262
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1000085103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical