Provider Demographics
NPI:1679548408
Name:WILSON, DONNA CATHERINE (EDD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:CATHERINE
Last Name:WILSON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 DRAGON WEED
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6379
Mailing Address - Country:US
Mailing Address - Phone:210-902-9790
Mailing Address - Fax:210-855-4408
Practice Address - Street 1:10010 ROGERS XING
Practice Address - Street 2:STE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4674
Practice Address - Country:US
Practice Address - Phone:210-902-9790
Practice Address - Fax:210-855-4408
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-3586103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist