Provider Demographics
NPI:1386066603
Name:WILSON, VONDA
Entity type:Individual
Prefix:
First Name:VONDA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 SNOW HILL RD # 200
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1939
Mailing Address - Country:US
Mailing Address - Phone:410-742-3460
Mailing Address - Fax:410-742-5810
Practice Address - Street 1:926 SNOW HILL RD # 200
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1939
Practice Address - Country:US
Practice Address - Phone:410-742-3460
Practice Address - Fax:410-742-5810
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)