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General NPI Number Information
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NPI Number | 1194442798
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Entity Type | Individual
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Provider Name | MARLO LEWIS WILSON LPC, LCMHC
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Gender | Female
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 199 EXCHANGE CIR UNIT 201
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-9709
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Country | US
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Telephone | 704-425-8086
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Fax |
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Provider Business Mailing Address
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Address Line | 199 EXCHANGE CIR UNIT 201
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-9709
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Country | US
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Telephone | 704-425-8086
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10880
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | WILS-87UXOJ
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License Number State | NC
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