Provider Demographics
NPI:1730486770
Name:WILSON, PAULA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MARIE
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 1:8378 DEKRUIF RD
Mailing Address - Street 2:
Mailing Address - City:LEVERING
Mailing Address - State:MI
Mailing Address - Zip Code:49755-9740
Mailing Address - Country:US
Mailing Address - Phone:231-622-3323
Mailing Address - Fax:231-681-1004
Practice Address - Street 1:3722 S STRAITS HWY
Practice Address - Street 2:
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749-5117
Practice Address - Country:US
Practice Address - Phone:231-622-3323
Practice Address - Fax:231-681-1004
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010902101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor