Provider Demographics
NPI:1821576257
Name:WILSON, MICHELLE NICOLE BARKER (LMFT, MCAP, IC-ADC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:NICOLE BARKER
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMFT, MCAP, IC-ADC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:NICOLE
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT, MCAP, IC-ADC
Mailing Address - Street 1:PO BOX 61421
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32236-1421
Mailing Address - Country:US
Mailing Address - Phone:904-891-5900
Mailing Address - Fax:
Practice Address - Street 1:6034 CHESTER AVE STE 106
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2237
Practice Address - Country:US
Practice Address - Phone:904-891-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-28
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMCAP0100540101YA0400X
101YM0800X, 101Y00000X
DCMT4212106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor