Provider Demographics
NPI:1639975501
Name:WILSON, SARAH VICTORIA (MS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:VICTORIA
Last Name:WILSON
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 THORNBERRY LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25320-7688
Mailing Address - Country:US
Mailing Address - Phone:304-415-8126
Mailing Address - Fax:
Practice Address - Street 1:5004 ELK RIVER RD
Practice Address - Street 2:
Practice Address - City:ELKVIEW
Practice Address - State:WV
Practice Address - Zip Code:25071
Practice Address - Country:US
Practice Address - Phone:304-415-8126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator