Provider Demographics
NPI:1891065264
Name:WILE, COLLEEN (MED, LMHC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:WILE
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 KIMBALL RD
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-5310
Mailing Address - Country:US
Mailing Address - Phone:508-423-4553
Mailing Address - Fax:
Practice Address - Street 1:104 KIMBALL RD
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-5310
Practice Address - Country:US
Practice Address - Phone:508-423-4553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8533101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor