Healthcare Provider Details

I. General information

NPI: 1093916264
Provider Name (Legal Business Name): MARQUITA D. WILSON LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 SEVEN MILE LN
PIKESVILLE MD
21208-4326
US

IV. Provider business mailing address

7924 LANSDALE RD
BALTIMORE MD
21224-2121
US

V. Phone/Fax

Practice location:
  • Phone: 410-887-1207
  • Fax: 410-887-1259
Mailing address:
  • Phone: 443-691-1929
  • Fax: 410-887-1259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberG11181
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14431
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: