Provider Demographics
NPI:1285961094
Name:WILSON, HOBSON IRVING (REGISTERED MHC INTER)
Entity type:Individual
Prefix:MR
First Name:HOBSON
Middle Name:IRVING
Last Name:WILSON
Suffix:
Gender:M
Credentials:REGISTERED MHC INTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2726
Mailing Address - Country:US
Mailing Address - Phone:954-584-4703
Mailing Address - Fax:
Practice Address - Street 1:4540 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2726
Practice Address - Country:US
Practice Address - Phone:954-584-4703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH7873101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health