Provider Demographics
NPI:1689333247
Name:WILSON, DELLA SAWYER (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DELLA
Middle Name:SAWYER
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 OXBOW DR STE 218
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5189
Mailing Address - Country:US
Mailing Address - Phone:214-675-0015
Mailing Address - Fax:
Practice Address - Street 1:1544 OXBOW DR STE 218
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5189
Practice Address - Country:US
Practice Address - Phone:214-675-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85526101YP2500X
CO0015902101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional