Provider Demographics
NPI:1760639215
Name:JANET C. WILSON, PH.D., ABPP, PLLC
Entity type:Organization
Organization Name:JANET C. WILSON, PH.D., ABPP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-521-1127
Mailing Address - Street 1:617 S TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1448
Mailing Address - Country:US
Mailing Address - Phone:703-521-1127
Mailing Address - Fax:703-348-3548
Practice Address - Street 1:617 S TAYLOR ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1448
Practice Address - Country:US
Practice Address - Phone:703-521-1127
Practice Address - Fax:703-348-3548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty