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General NPI Number Information
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NPI Number | 1316181399
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Entity Type | Individual
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Provider Name | LAURIE L WILSON L.P.C., LMFT
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Gender | Female
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Dates
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Enumeration Date | 04/22/2009
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 17521 TRIPOLI BLVD
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City | DUMFRIES
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State | VA
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Zip | 22026-2239
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Country | US
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Telephone | 703-615-2891
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Fax | 703-791-3123
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Provider Business Mailing Address
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Address Line | 13614 HIDDEN CREEK RD
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City | MANASSAS
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State | VA
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Zip | 20112-5577
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Country | US
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Telephone | 703-615-2891
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Fax | 703-791-3123
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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 | 0717000399
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701002089
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License Number State | VA
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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 | 0717000399
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License Number State | VA
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