Healthcare Provider Details

I. General information

NPI: 1942449616
Provider Name (Legal Business Name): LISA MARIE WILSON M.S.W.,L.C.S.W., Q.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2538
US

IV. Provider business mailing address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2538
US

V. Phone/Fax

Practice location:
  • Phone: 910-449-8727
  • Fax: 910-450-3319
Mailing address:
  • Phone: 910-450-3319
  • Fax: 910-450-3319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC007465
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: