Provider Demographics
NPI:1861758377
Name:WILCOX, DAVID ARTHUR JR (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ARTHUR
Last Name:WILCOX
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 PINE TREE LN
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-2208
Mailing Address - Country:US
Mailing Address - Phone:863-207-1110
Mailing Address - Fax:
Practice Address - Street 1:5925 IMPERIAL PKWY
Practice Address - Street 2:SUITE 128
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860-8476
Practice Address - Country:US
Practice Address - Phone:863-207-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9617101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health