| Philicia Jefferson Wilson | |
|
4936 Southpoint Pkwy Fredericksburg VA 22407-2659 | |
| (540) 710-0520 | |
| (703) 490-3544 |
| Full Name | Philicia Jefferson Wilson |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 4936 Southpoint Pkwy, Fredericksburg, Virginia |
| Authorized Official Name and Position | Philicia Jefferson (DIRECTOR) |
| Authorized Official Contact | 5407100520 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Philicia Jefferson Wilson Po Box 42111 Fredericksburg VA 22404-2111 Ph: (540) 710-0520 | Philicia Jefferson Wilson 4936 Southpoint Pkwy Fredericksburg VA 22407-2659 Ph: (540) 710-0520 |
| NPI Number | 1699705459 |
|---|---|
| Provider Enumeration Date | 07/04/2006 |
| Last Update Date | 06/19/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699705459 | NPI | - | NPPES |
| 258225000 | Other | VA | MENTAL HEALTH OUTPATIENT |
| 441462 | Other | VA | OUT-PATIENT MENTAL HEALTH |
| 010200113 | Medicaid | VA | |
| 010276128 | Medicaid | VA | |
| 005411041 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 831 (Virginia) | Primary |
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