Provider Demographics
NPI:1831947746
Name:WILSON, VEVELYN PETERSON
Entity type:Individual
Prefix:MRS
First Name:VEVELYN
Middle Name:PETERSON
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VEVELYN
Other - Middle Name:PETERSON
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-0235
Mailing Address - Country:US
Mailing Address - Phone:205-693-9039
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 235
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-0235
Practice Address - Country:US
Practice Address - Phone:205-639-9039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4081C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical