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General NPI Number Information
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NPI Number | 1992959894
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Entity Type | Individual
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Provider Name | LERNARD WILSON MA, LMHC, NCC, CSMS
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Gender | Male
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Dates
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Enumeration Date | 11/05/2008
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Last Update Date | 11/05/2008
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Provider Practice Location Address
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Address Line | 2210 S RIO GRANDE AVE
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City | ORLANDO
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State | FL
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Zip | 32805-5262
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Country | US
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Telephone | 321-206-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 6820 NAWADAHA BLVD
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City | ORLANDO
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State | FL
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Zip | 32818-5365
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Country | US
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Telephone | 321-206-6300
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Fax | 407-290-9787
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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 | MH7412
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License Number State | FL
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