Provider Demographics
NPI:1396803078
Name:DONNA WILSON PSYCHOTHERAPY INC
Entity type:Organization
Organization Name:DONNA WILSON PSYCHOTHERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:727-576-3300
Mailing Address - Street 1:7901 4 ST NO
Mailing Address - Street 2:327
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702
Mailing Address - Country:US
Mailing Address - Phone:727-576-3300
Mailing Address - Fax:727-576-2300
Practice Address - Street 1:7901 4 ST NO
Practice Address - Street 2:327
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702
Practice Address - Country:US
Practice Address - Phone:727-576-3300
Practice Address - Fax:727-576-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ0318Medicare ID - Type Unspecified