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General NPI Number Information
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NPI Number | 1437450988
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Entity Type | Individual
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Provider Name | TERESA S WILSON LPC, LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/14/2010
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 650 PENNSYLVANIA AVE SE SUITE 240
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City | WASHINGTON
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State | DC
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Zip | 20003-4318
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Country | US
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Telephone | 202-544-5440
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Fax |
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Provider Business Mailing Address
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Address Line | 21 N ROLLING RD
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City | CATONSVILLE
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State | MD
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Zip | 21228-4849
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Country | US
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Telephone | 410-227-7191
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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 | PRC14103
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT000138
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License Number State | DC
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