Provider Demographics
NPI:1003413345
Name:WILSON, NADA S
Entity Type:Individual
Prefix:
First Name:NADA
Middle Name:S
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 HUNTERS VIEW RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6109
Mailing Address - Country:US
Mailing Address - Phone:240-271-0079
Mailing Address - Fax:
Practice Address - Street 1:VESTA
Practice Address - Street 2:9301 ANNAPOLIS RD
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1001
Practice Address - Country:US
Practice Address - Phone:240-296-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12696101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional