Provider Demographics
NPI:1083289979
Name:WILSON, BRIAN CRAIG (LPC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:CRAIG
Last Name:WILSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 LEHIGH ST
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-3117
Mailing Address - Country:US
Mailing Address - Phone:201-741-6295
Mailing Address - Fax:
Practice Address - Street 1:498 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1930
Practice Address - Country:US
Practice Address - Phone:973-839-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00756500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional