Provider Demographics
NPI:1003580473
Name:WILSON, LAURA (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 NEW CREEK HWY
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-8215
Mailing Address - Country:US
Mailing Address - Phone:304-813-2884
Mailing Address - Fax:304-788-2409
Practice Address - Street 1:16913 KNOBLEY RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WV
Practice Address - Zip Code:26710
Practice Address - Country:US
Practice Address - Phone:304-289-3696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP00943189104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker