Provider Demographics
NPI:1952810525
Name:WILES, JAY (PSYD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:WILES
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 BRYCE CIR STE C
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4842
Mailing Address - Country:US
Mailing Address - Phone:864-420-3605
Mailing Address - Fax:
Practice Address - Street 1:205 BRYCE CIR STE C
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-4842
Practice Address - Country:US
Practice Address - Phone:864-420-3605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005806103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth