Provider Demographics
NPI:1063514933
Name:WILSON, CARLITA N (MSW)
Entity type:Individual
Prefix:MS
First Name:CARLITA
Middle Name:N
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20548 FENKELL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-1613
Mailing Address - Country:US
Mailing Address - Phone:313-255-3333
Mailing Address - Fax:313-255-4335
Practice Address - Street 1:20548 FENKELL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-1613
Practice Address - Country:US
Practice Address - Phone:313-255-3333
Practice Address - Fax:313-255-4335
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801034657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health