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General NPI Number Information
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NPI Number | 1386795250
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Entity Type | Individual
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Provider Name | LEON M WILSON LPC
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 307 LAFAYETTE BLVD STE 202
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-6079
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Country | US
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Telephone | 703-915-9526
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Fax | 240-595-6187
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Provider Business Mailing Address
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Address Line | PO BOX 297
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City | HARTWOOD
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State | VA
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Zip | 22471-0297
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Country | US
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Telephone | 703-915-9526
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Fax | 240-595-6187
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701003698
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License Number State | VA
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