Dava R Wilson, CSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

253861 Issued in KY

Practice address

1143 Fairway St Ste 320
Bowling Green, KY 42103-2452

Phone

(270) 904-6307

Fax

(270) 904-6314

NPI assigned

Apr 9, 2019

Last updated

Apr 9, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dava Whitaker Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: dava.wilson.1@19494.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932
  Medicare reassignment

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

{
    "created_epoch": "1554768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554768000000",
    "number": "1619430444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10100 ELIDA RD",
            "city": "DELPHOS",
            "state": "OH",
            "postal_code": "458339058",
            "telephone_number": "419-695-8010",
            "fax_number": "419-695-0004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1143 FAIRWAY ST STE 320",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421032452",
            "telephone_number": "270-904-6307",
            "fax_number": "270-904-6314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DAVA",
        "middle_name": "R",
        "credential": "CSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-09",
        "last_updated": "2019-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "253861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAVA",
            "last_name": "WHITAKER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Wilson Counseling, LLC (Wilson Place)
• Alexis Renee Wilson
• Allison L Wilson, DPT
• Amanda Wilson
• Bionca Wilson
• Demara Wilson
• Dustin Ray Wilson, MS ATC CSCS
• Gene O'Neil Wilson Jr., M.D.
• Jessica Evelynne Wilson, M.S., CCC-SLP
• Kimberly R Wilson, LCSW

• Clinical Social Worker in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Clinical Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.