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General NPI Number Information
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NPI Number | 1225003403
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Entity Type | Individual
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Provider Name | WILLETTA M. WILSON LMFT, LPC, MAC, BC-
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Gender | Female
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | A.T. AUGUSTA MILITARY MEDICAL CENTER 9300 DEWITT LOOP; RIVER PAVILION
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City | FORT BELVOIR
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State | VA
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Zip | 22060
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Country | US
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Telephone | 571-231-3224
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Fax | 571-231-6623
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Provider Business Mailing Address
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Address Line | 24 TOWNES PL
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City | FREDERICKSBURG
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State | VA
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Zip | 22405-2091
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Country | US
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Telephone | 703-303-0039
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401007409
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License Number State | MI
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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 | PRC13727
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT000060
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701005368
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License Number State | VA
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