Provider Demographics
NPI:1932363686
Name:WILSON, JOELEATHIA DOBBINS (LCSW, CSOTP)
Entity type:Individual
Prefix:
First Name:JOELEATHIA
Middle Name:DOBBINS
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW, CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10305 MEMORY LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-8815
Mailing Address - Country:US
Mailing Address - Phone:804-257-9324
Mailing Address - Fax:
Practice Address - Street 1:10305 MEMORY LN
Practice Address - Street 2:SUITE 202
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-8815
Practice Address - Country:US
Practice Address - Phone:804-257-9324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040064191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical