| Name: | Wilson Psychology Group, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 03 Nov 2020 (4 years ago) (Companies founded in November 2020) |
| Entity Number: | 000-820-206 |
| Register Number: | 000820206 |
| ZIP code: | 36303 (Companies in Houston, 36303) |
| County: | Houston |
| Place of Formation: | Houston County |
| Registered Office Street Address: | 212 W TROY ST STE BDOTHAN, AL 36303 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851981641 | 2021-01-25 | 2021-01-25 | 1115 LEIGHTON AVE STE 1-A, ANNISTON, AL, 362074610, US | 1115 LEIGHTON AVE STE 1-A, ANNISTON, AL, 362074610, US | |||||||||||||||||||||
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| Phone | +1 256-238-8113 |
| Fax | 2562388955 |
Authorized person
| Name | DR. EMMA HIATT WILSON |
| Role | LICENSED PSYCHOLOGIST |
| Phone | 2562388113 |
Taxonomy
| Taxonomy Code | 103T00000X - Psychologist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1184829145 |
| State | CA |
| Name | Role | Address |
|---|---|---|
| REGISTERED AGENTS INC | Agent | 212 W. TROY ST. STE BDOTHAN, AL 36303 |
| Name | Role | Address |
|---|---|---|
| PEREZ, AYLEEN | Organizer | 212 W TROY ST STE BDOTHAN, AL |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
