Provider Demographics
NPI:1790223600
Name:WILSON, QUNIQUE
Entity Type:Individual
Prefix:
First Name:QUNIQUE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 SEA OATS CIR
Mailing Address - Street 2:301
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-8037
Mailing Address - Country:US
Mailing Address - Phone:434-806-4627
Mailing Address - Fax:
Practice Address - Street 1:4719 SEA OATS CIR
Practice Address - Street 2:301
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-8037
Practice Address - Country:US
Practice Address - Phone:434-806-4627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health