Provider Demographics
NPI:1598181109
Name:WILSON, DARIUS SR (CBHT)
Entity Type:Individual
Prefix:MR
First Name:DARIUS
Middle Name:
Last Name:WILSON
Suffix:SR
Gender:M
Credentials:CBHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 32ND AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-7701
Mailing Address - Country:US
Mailing Address - Phone:727-824-5731
Mailing Address - Fax:727-824-5731
Practice Address - Street 1:620 32ND AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-7701
Practice Address - Country:US
Practice Address - Phone:727-824-5731
Practice Address - Fax:727-824-5731
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health