Healthcare Provider Details

I. General information

NPI: 1003424078
Provider Name (Legal Business Name): MARQUITA LACHETTE WILSON M.ED., LPC, LGC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S MAIN ST
NEWTON MS
39345-2613
US

IV. Provider business mailing address

PO BOX 117
FOREST MS
39074-0117
US

V. Phone/Fax

Practice location:
  • Phone: 601-900-8632
  • Fax:
Mailing address:
  • Phone: 601-900-8632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number324167
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2729
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2729
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: