Betty Jean Wilson, LICDC-CS

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

913005 Issued in OH

Practice address

2447 Nebraska Ave
Toledo, OH 43607-3531

Phone

(419) 255-4444

NPI assigned

Feb 19, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1582070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582070400000",
    "number": "1417580481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2447 NEBRASKA AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436073531",
            "telephone_number": "419-255-4444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2447 NEBRASKA AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436073531",
            "telephone_number": "419-255-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "BETTY",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "LICDC-CS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-19",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "913005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER LICENSE LICDC-CS",
            "identifier": "913005",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bwilson@kipu.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2447 Nebraska Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436073531",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Andrea Antoinette Wilson Love Blackwell
• Jessica Wilson-Sobb
• Aaliyah Monea Wilson
• Andreas Wilson
• April Latrice Wilson, LPN
• Bradley Clark Wilson
• Brandy Wilson, LPN
• Christina Ann Wilson
• Courtney Lorraine Wilson
• Debra Wilson

• Addiction (Substance Use Disorder) Counselor in Toledo, OH
• Providers in Toledo, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.