Provider Demographics
NPI:1962709469
Name:WILSON, ANGIE D (PHD, LPC, LSOTP)
Entity type:Individual
Prefix:DR
First Name:ANGIE
Middle Name:D
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHD, LPC, LSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2803
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-2803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 HWY 24
Practice Address - Street 2:PSYCHOLOGY, COUNSELING, SPEICAL ED - BINNION HALL
Practice Address - City:COMMERCE
Practice Address - State:TX
Practice Address - Zip Code:75429
Practice Address - Country:US
Practice Address - Phone:906-886-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional