Provider Demographics
NPI:1730520941
Name:WILSON, VALYNCIA MONIQUE (MS, CRC, LPC)
Entity type:Individual
Prefix:MS
First Name:VALYNCIA
Middle Name:MONIQUE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12457 E 36TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-3202
Mailing Address - Country:US
Mailing Address - Phone:918-814-5637
Mailing Address - Fax:
Practice Address - Street 1:130 N GREENWOOD AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-1443
Practice Address - Country:US
Practice Address - Phone:918-814-5637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6419101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health