Provider Demographics
NPI:1447314133
Name:WILSON, JOSANNE V (LMFT)
Entity type:Individual
Prefix:
First Name:JOSANNE
Middle Name:V
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 RICHLAND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2519
Mailing Address - Country:US
Mailing Address - Phone:803-748-1010
Mailing Address - Fax:803-748-0522
Practice Address - Street 1:1415 RICHLAND ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2519
Practice Address - Country:US
Practice Address - Phone:803-748-1010
Practice Address - Fax:803-748-0522
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC72106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist