Provider Demographics
NPI:1184747990
Name:WILSON, JESSICA MITCHELL (COUNSELOR)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MITCHELL
Last Name:WILSON
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 MAPLE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02019-1666
Mailing Address - Country:US
Mailing Address - Phone:303-519-3235
Mailing Address - Fax:
Practice Address - Street 1:251 W CENTRAL ST
Practice Address - Street 2:SUITE 25
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3758
Practice Address - Country:US
Practice Address - Phone:508-653-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2014-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health