Provider Demographics
NPI:1598475485
Name:WILSON, ARIEL MICHELLE (RMHCI)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:MICHELLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 JACARANDA ST
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-5901
Mailing Address - Country:US
Mailing Address - Phone:321-368-4308
Mailing Address - Fax:
Practice Address - Street 1:590 SOLUTIONS WAY STE 120
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3623
Practice Address - Country:US
Practice Address - Phone:321-368-4308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMH22765101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIMH22765OtherLICENSE NUMBER