Active NPI
Kristin A Wilson, MA, LPC, DTR
- Professional Counselor
- Media, PA
National Provider Identifier
1679670848
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- PC002406
- Practice address
- 710 S Old Middletown Rd
Media, PA 19063-5024 - Phone
- (610) 619-9870
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | PC002406 | PA | Primary |
Addresses
Primary practice location
710 S Old Middletown Rd
Media, PA 19063-5024
Mailing address
42 Enlow PL
Pennsville, NJ 08070-2031
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC002406 | PA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679670848",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "42 ENLOW PL",
"city": "PENNSVILLE",
"state": "NJ",
"postal_code": "080702031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 S OLD MIDDLETOWN RD",
"city": "MEDIA",
"state": "PA",
"postal_code": "190635024",
"telephone_number": "610-619-9870"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KRISTIN",
"middle_name": "A",
"name_prefix": "Mrs.",
"credential": "MA, LPC, DTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "PA",
"license": "PC002406",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Media, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.