Healthcare Provider Details

I. General information

NPI: 1285567677
Provider Name (Legal Business Name): MELISSA WILSON LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 ROUTE 46 STE 8
PARSIPPANY NJ
07054-4914
US

IV. Provider business mailing address

1280 ROUTE 46 STE 8
PARSIPPANY NJ
07054-4914
US

V. Phone/Fax

Practice location:
  • Phone: 973-908-1917
  • Fax:
Mailing address:
  • Phone: 973-908-1917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00965100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: