Provider Demographics
NPI:1043372865
Name:WILSON, MARIE DELORES (PHD, ATR-BC, LPC)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:DELORES
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHD, ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 KEITH LN
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-5049
Mailing Address - Country:US
Mailing Address - Phone:610-248-4943
Mailing Address - Fax:
Practice Address - Street 1:2020 DOWNYFLAKE LN
Practice Address - Street 2:SUITE 302A
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-4917
Practice Address - Country:US
Practice Address - Phone:610-248-4943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001865101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional