MEDICARE: ANGELA WILSON MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	9586	MA
2	101YP2500X	Professional Counselor	0701012949	VA

General Provider Information

NPI Number	:	1407169980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA WILSON MA, LPC

Provider Business Mailing Address
First Line	:	15521 MIDLOTHIAN TPKE STE 105
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-7313
Country	:	US
Telephone Number	:	804-207-6737
Fax Number	:

Provider Business Practice Location Address
First Line	:	15521 MIDLOTHIAN TPKE STE 105
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-7313
Country	:	US
Telephone Number	:	804-207-6737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2010
Last Update Date	:	01/14/2026

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