Provider Demographics
NPI:1033347513
Name:WILSON, ADALAY M (LCSW)
Entity Type:Individual
Prefix:
First Name:ADALAY
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1004
Mailing Address - Country:US
Mailing Address - Phone:757-490-9797
Mailing Address - Fax:757-490-8324
Practice Address - Street 1:815 BAKER RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1004
Practice Address - Country:US
Practice Address - Phone:757-490-9797
Practice Address - Fax:757-490-8324
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040020351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical