Provider Demographics
NPI:1184749954
Name:WILSON, SHIRLEY H (LPCMH)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:H
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 AIRPORT RD.
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963
Mailing Address - Country:US
Mailing Address - Phone:302-422-8026
Mailing Address - Fax:302-422-0701
Practice Address - Street 1:1131 AIRPORT RD.
Practice Address - Street 2:SUITE 5
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963
Practice Address - Country:US
Practice Address - Phone:302-422-8026
Practice Address - Fax:302-422-0701
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC0000297101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000025946Medicaid
DE370243OtherTRICARE PIN