Raven Wilson
Raven Wilson is a Mental Health Counselor in Plattsburgh, New York. Qualified in 2016, 10 years ago. Practices with Conifer Park Inc, a 12-clinician group and accepts Medicare assignment. Licensed in New York.
- Years since qualifying
- 10
- Licensed in
- NY
- In the registry since
- 2016
- Specialties on file
- 2
Practice location Address checks out
80 Sharron AvePlattsburgh, NY 12901-4700
Phone: (518) 561-1447
Fax: (518) 562-8812
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Mental Health Counselor (primary) | Taxonomy 101YM0800X · Licence 010789 (NY) |
|---|---|
| Addiction (Substance Use Disorder) Counselor | Taxonomy 101YA0400X · Licence 33417 (NY) |
Record details
| NPI number | 1740725050 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Female |
| Sole proprietor | No |
| NPI enumerated | December 21, 2016 |
| Last updated in NPPES | January 12, 2021 |
| Certification date | January 12, 2021 |
| Mailing address | 79 Glenridge Rd, Glenville, NY 12302-4523 |
Medicare enrollment
| Medicare specialty | MENTAL HEALTH COUNSELOR |
|---|---|
| Medical school | OTHER |
| Graduated | 2016 (10 years in practice) |
| Group practice | Conifer Park Inc — 12 clinicians |
| Accepts Medicare assignment | Yes — accepts the Medicare-approved amount |
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