Provider Demographics
NPI:1174396279
Name:WILSON, PAUL MICHAEL (MHC-LP)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHAEL
Last Name:WILSON
Suffix:
Gender:M
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 HILTON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2817
Mailing Address - Country:US
Mailing Address - Phone:516-798-4070
Mailing Address - Fax:
Practice Address - Street 1:65 HILTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2817
Practice Address - Country:US
Practice Address - Phone:516-798-4070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health